Volunteer Background Check Authorization

We will demand background checks for our volunteers working directly with children in order to ensure a safe environment for your kids and our staff. In light of what has been occurring in schools across the country, we have implemented this policy. Chaperoning, driving on field trips, becoming a room mom, or being a teacher’s assistant are just a few examples of working with children. Generally through a program called Protect My Ministry, we are able to perform a background investigation. Overall please submit this form to the office of the school. 

Name:                                                                                                                                              

(First)                                                 (Middle)                                              (Last)

 

Former Name(s) and Dates Used:                                                                                                

 

Current Address Since:                                                                                                                    

(Mo/Yr)               (Street)                                (City)                   (Zip/State)

 

Previous Address From:                                                                                                         

(Mo/Yr)              (Street)                                (City)                   (Zip/State)

 

Previous Address From:                                                                                                                

(Mo/Yr)              (Street)                                (City)                   (Zip/State)

Social Security Number:                                                 Telephone Number:                                 

Drivers License Number/State:                                      Date of Birth:                                               

 

Additionally, to the best of my knowledge, the information in this application is accurate. So far I hereby provide permission for Hope Lutheran Church and School and its approved agents and representatives to do a thorough background check on me and create a consumer report and/or an investigative consumer report for volunteer or employment purposes. I am aware that the scope of a consumer report or an investigative consumer report may cover the following topics, without being limited to them: social security number verification; current and previous addresses; employment history, educational background, and character references; drug testing; civil and criminal history records from any criminal justice agency in any or all federal, state, or county jurisdictions; driving records; birth records; and any other public records.

 

The Social Security Administration, and any of their officers, employees, representatives, or assigned agencies, individually and collectively, from any and all liability for any damages of any kind that may, at any time, result to me, my heirs, family, or associates due to the execution of this authorization and request to release.

Signature:                                                           Date: _________________________                          

A background investigation was done on the aforementioned volunteer, and nothing significant or pertinent was discovered against him/her. Therefore, it has been decided that this person is qualified to volunteer.

 

Approved by

Name      _________________________________________                                                                          

Title        _________________________________________                                           

Date     _________________________________________

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