Permission to Obtain a Background Check

Permission to Obtain a Background Check *
This form authorizes the Pathway Vineyard church to obtain background information and must be completed by the applicant. I, the undersigned applicant, authorize The Pathway Vineyard through its independent contractor, to produce background information about me. I understand that this authorization and release is valid for future background information requests during my period of service with The Pathway Vineyard for the purpose of investigating any incidents of workplace misconduct or criminal activity for which I am alleged to have been involved during my service. These above mentioned reports may include my driving history, including any traffic citations; a social security number trace; present and former addresses; criminal and civil history/records; any other public record. I further authorize any person, business entity or governmental agency that may have relevant information to disclose it to The Pathway Vineyard through its independent contractor, including any courts, public agencies, law enforcement agencies and credit bureaus. I understand that I am entitled to a complete copy of any background information report of which I am the subject upon my written request to The Pathway Vineyard, if such is made within a reasonable time from the date it was produced. I also understand that I may receive a written summary of my rights under the Fair Credit Reporting Act and the California Civil Code.
Identifying Information for Background Information Agency
Your Name *
Your Name
Please include your first and any middle name(s) in the first box.
Gender *
Current Address *
Current Address
Daytime Phone Number *
Daytime Phone Number
Date of Birth *
Date of Birth
Are you a Christian
Criminal Offense Record
Have you ever been convicted of a criminal offense? *
Have you been convicted of child abuse or sexual abuse or been involved in any activities related to molesting or abusing children/youth?