Background Check

Backgound Check

I have read, and understand:*

I Agree

This form authorizes the church to obtain background information and must be completed by the applicant. The church must keep this completed form on file at least two years after requesting a background check.

I have read and agree:*

I Agree

I, the undersigned applicant (also known as "consumer"). authorize EAST POINTE CHURCH through its independent contractor, LexisNexis, to procure background information (also known as a "consumer report and/or investigative consumer report") about me. This report may include my driving history, including any traffic citations; a social security number verification; present and former addresses; criminal and civil history/records; and the state sex offender records. I understand that I am entitled to a complete copy of any background information report of which I am the subject upon my request to EAST POINTE CHURCH 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.

Name*

Application Date:*

Other Names (alias, maiden, nickname)

Address*

Social Security Number:*

Phone*( ) -

Email*

Driver's License Number*

State of Issuance*

Date of Birth*

Gender*

Please leave this field blank.

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