BACKGROUND CHECK AUTHORIZATION & CONSENT FORM

Name Signature CHECK

Name *

First

Last

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

BACKGROUND CHECK AUTHORIZATION *

I, the undersigned, hereby authorize First Haitian Church of God of West Palm Beach, and/or its authorized representatives, to obtain and review information concerning my background for the purpose of determining my suitability for employment, volunteer service, ministry involvement, leadership responsibilities, or other positions of trust within the church. I understand that the background check may include, as permitted by applicable law, a review of criminal history records and other relevant public records. If applicable to the position, the background screening may also include information related to driving records, employment history, education, professional credentials, or other information reasonably related to the responsibilities of the position. I understand that the information obtained through this process will be used solely for legitimate organizational purposes and will be handled as confidentially as reasonably possible and in accordance with applicable federal, state, and local laws. I understand that providing this authorization does not guarantee employment, volunteer placement, ministry assignment, or continued service with the church. I certify that the information I have provided on this form is true and complete to the best of my knowledge. I understand that providing false or incomplete information may result in denial or termination of employment, volunteer service, or ministry responsibilities. I authorize the release of relevant information necessary to complete the background screening and agree to cooperate with the process if additional information or documentation is required.

Marital Status *

Single
Married
Separated
Divorced

Signature *

Clear Signature

WPBCOG

CHURCH OF GOD

BACKGROUND CHECK AUTHORIZATION & CONSENT FORM