Background Check Release

Please fill out this form and click submit.

Name

*

Phone

*

Email

*

This address will receive a confirmation email

Address

*

Have you lived outside of Texas?

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Please select one option.

Yes No

if yes, please list locations and dates.

Social Security Number

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Drivers License Number (include issuing state)

*

Date of Birth

*

Have you ever been arrested, charged, or convicted of any offense other than a class C misdemeanor (i.e. traffic citation)?

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Please select one option.

Yes No

If yes, please describe the nature of your arrest/offense.

By providing the requested information, I understand that I am giving Southwest Christian Church and its agents permission to use provided data to access any and all public records information relating to my criminal history.

*

Please select one option.

Yes No

I understand that all information gathered will be considered in determining my suitability as a staff person at Southwest, that all findings will be kept confidential, and that if a disqualifying offense is found I will be notified.

*

Please select one option.

Yes No

I intend this to be a legally binding release, which I have read and understand.

*

Please select one option.

Yes No

Today's Date

*

Description

Please fill out this form and click submit.

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