Background Investigation Authorization - The Lutheran Church of the Holy Spirit

To authorize a volunteer background investigation, first complete this form and then a Volunteer Background Investigation Affidavit. After completing this form click on "Submit" below. You will receive an emailed copy of the completed form. Sign and print the form and return to the church office for processing. Alternatively, you can You can also choose to You can also choose to

I hereby authorize the :Lutheran Church of The Holy Spirit and/or its agents to make an independent investigation of my criminal background, including any record of convictions, driving records, registered sex offender or police records, including those maintained by both public and private organizations and all public records (local, state or national) for the purpose of confirming the information contained on my application and/or obtaining other information, which may be material to my qualifications for employment now, and if applicable, during the tenure of my employment/volunteer work with the Lutheran Church of The Holy Spirit. I release the Lutheran Church of The Holy Spirit and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims, or law suits in regards to the information obtained from any and all of the above referenced sources used. The following is my true and complete legal name, and all information is true and correct to the best of my knowledge.

Applicant's Full Name *

Gender *

Male
Female

Maiden Name or Other Names Used

Email *

Present Address *

How Long (years + months) *

Former Address

Note: The Child Abuse Certification process will require addresses covering the last 10 consecutive years.

How Long (years + months)

Additional Former Address

How Long (years + months)

Date of Birth *

Social Security Number *

Position *

Volunteer
Employee

Signature

If completing on-line, print and sign the emailed copy. If completing manually, sign the printed copy.

Date

Date at time of signing.

When you press "Submit" below a copy of your completed form will be forwarded to you as an email. In addition you will be taken to a second required Affidavit statement. Please complete this second form also. After you have received both emailed forms, print them and sign both. You will need to have a witness co-sign your affidavit. Drop both forms at the church office so we c an process your application. Thank-you for your assistance.

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