Redeemer Church | Dewitt, MI - Driving Record/Background Check

Personal Information

First Name

Middle Name

Last Name

Previous Names

Gender

Male

Female

Birthdate

Social Security Number

Driver's License Number

Contact Information

Email

Phone Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

County

Ministry

What ministry area are you volunteering for?

History

Have you been convicted of, or pleaded guilty to, or are charges pending concerning any criminal offense?

Yes

No

If yes, please explain:

Have you ever abused a minor or engaged in any conduct that could be regarded as child abuse, child sexual abuse, or neglect?

Yes

No

If yes, please explain:

In addition to the above, is there any fact or circumstances involving you or your background that would call into question your being entrusted with the care and supervision of children or youth?

Yes

No

If yes, please explain:

Consent

I hereby give consent to Redeemer Church to conduct a background check on me, as I am seeking to be a volunteer working with children, disabled or vulnerable adults, elderly persons, or financial matters. I authorize references listed to give you any information (including opinions) that they may have regarding my character and fitness for ministry with children or youth. I hereby release and agree to hold harmless from liability any person or organization that provides information, and I waive any right to inspect any information provided about me. I also agree to hold harmless Redeemer Church, and its paid staff members and volunteers. I authorize the release of any information which pertains to any record of convictions contained in law enforcement files or in any criminal file maintained on me whether it be local, state, or national. I hereby release local, state, and national law enforcement agencies from any and all liability resulting from such disclosure.

I agree to the above and authorize my electronic signature.

Driving Record/Background Check

Personal Information

Contact Information

Ministry

History

Consent

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