Social Security #
All volunteers 18+ years old must complete a background check. If you are 18+ years old, your SSN is required in order to complete this application.
Please List Other Names Used Including Maiden Names/Alias/Previous Married Names or Other
How long have you attended Calvary Church?
Personal ReferencesPlease list 2 personal references we have your permission to contact. References should not be related to you.
Reference #1 Full Name & Relationship to Registrant
Reference #1 Primary Phone Number
Reference #2 Full Name & Relationship to Registrant
Reference #2 Primary Phone Number
Student Volunteer Information
Please indicate if you are in Junior High (grades 6-8) or High School (grades 9-12).
DISCLOSURE REGARDING BACKGROUND INVESTIGATIONIn connection with my application for employment or to serve as a volunteer with Calvary Church (“Client’), I understand that a “consumer report” and/or “investigative consumer report”, as defined by the Fair Credit Reporting Act (15 U.S.C. § 1681), will be requested by Client for employment or volunteer purposes, whichever is applicable, from Protect My Ministry, Inc., (“Protect My Ministry”), a consumer reporting agency as defined by the Fair Credit Reporting Act. These reports may include information as to my character, general reputation, personal characteristics or mode of living, whichever are applicable. They may involve interviews with sources such as my neighbors, friends or associates. The report may also contain information about me relating to my criminal history, credit history, driving and/or motor vehicle records, social security number verification, verification of education or employment history, worker’s compensation (only after a conditional job offer) or other background checks. Such reports may be obtained only after I have been determined qualified for the position and notified of an impending review, or, if I am not being interviewed, only after a conditional offer of employment, and only after receipt of this Disclosure and Authorization if I am hired or serve as a volunteer, whichever is applicable, such reports may be obtained throughout the course of my employment or volunteer service, as permitted by law and unless revoked by me in writing. Client also reserves the right to share my report with any third-party with whom I will be placed to work or volunteer with as a representative of Client. I understand that I have the right, upon written request made within a reasonable amount of time after the receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report to Protect My Ministry, Inc., 14499 N. Dale Mabry Hwy., Suite 201 South, Tampa, FL 33618 or 1-800-319-5581. For information about Protect My Ministry’s privacy practices, see www.protectmyministry.com.
Applicant's Disclosure & Authorization
ACKNOWLEDGEMENT AND AUTHORIZATIONI acknowledge receipt of the separate document entitled DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by CALVARY CHURCH and/or its authorized agent(s) at any time after receipt of this authorization and throughout my employment, and throughout my time serving as a volunteer, if applicable.
I further hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by CALVARY CHURCH and/or its authorized agent(s). I agree that an electronic, photographic, and/or faxed copy of this Acknowledgment and Authorization shall be as valid as the original.
Applicant's Acknowledgement & Authorization
Your Full Name