Volunteer Screening Form Woodlawn Christian Church
Volunteer Screening Form Woodlawn Christian Church Name (First, Middle, Last): SSN:
_______________________________
Address:
1.
If Yes, please explain:
No
If Yes, please explain:
No
If Yes, please explain:
No
If Yes, please explain:
If you answered yes to any of the questions above, did any of these offenses involve a minor?
Yes A. B. C. D.
No
As of the date of this authorization, do you have any pending criminal charges against you?
Yes 5.
_______________________
Have you ever been convicted of any criminal offense in a country outside the jurisdiction of the United States?
Yes 4.
City/Zip:
________________
Have you ever received probation or community supervision for any federal, state or municipal criminal offense?
Yes 3.
______________________________
Birthdate (M,D,Y):
Have you ever been convicted or plead guilty before a court of any federal, state, or municipal criminal offense? (Excluding minor traffic violations)
Yes 2.
________________________________________________________
No
If Yes, please explain:
Are you a member of Woodlawn Christian Church? I work with children at my current place of employment. I have a background check on file at my current place of employment. If “C” is “yes,” this check was completed within the past 24 months.
Yes Yes Yes Yes
No No No No
I give my consent for Woodlawn Christian Church to conduct a background check with Secure Search Pro (www.securesearchpro.com) using the information provided above. I understand that this material will be kept confidential, and that periodic background reviews may be completed in the future using the information provided. If I work with children at my current place of employment and have a background check on file which has been completed in the past 24 months, I give my permission for my employer to verify that the background check is on file and meets the criteria posted above. Name (print):
_____________________________________________ Date:
_________________
Signature:
______________________________________________________________________
_______________________________
Address:
1.
If Yes, please explain:
No
If Yes, please explain:
No
If Yes, please explain:
No
If Yes, please explain:
If you answered yes to any of the questions above, did any of these offenses involve a minor?
Yes A. B. C. D.
No
As of the date of this authorization, do you have any pending criminal charges against you?
Yes 5.
_______________________
Have you ever been convicted of any criminal offense in a country outside the jurisdiction of the United States?
Yes 4.
City/Zip:
________________
Have you ever received probation or community supervision for any federal, state or municipal criminal offense?
Yes 3.
______________________________
Birthdate (M,D,Y):
Have you ever been convicted or plead guilty before a court of any federal, state, or municipal criminal offense? (Excluding minor traffic violations)
Yes 2.
________________________________________________________
No
If Yes, please explain:
Are you a member of Woodlawn Christian Church? I work with children at my current place of employment. I have a background check on file at my current place of employment. If “C” is “yes,” this check was completed within the past 24 months.
Yes Yes Yes Yes
No No No No
I give my consent for Woodlawn Christian Church to conduct a background check with Secure Search Pro (www.securesearchpro.com) using the information provided above. I understand that this material will be kept confidential, and that periodic background reviews may be completed in the future using the information provided. If I work with children at my current place of employment and have a background check on file which has been completed in the past 24 months, I give my permission for my employer to verify that the background check is on file and meets the criteria posted above. Name (print):
_____________________________________________ Date:
_________________
Signature:
______________________________________________________________________
