Background Check Form

FAITH Home School, Inc.

Families Active In Teaching at Home

P.O. Box 354 Stephenville, Texas 76401

“For I know the thoughts that I think toward you, saith the LORD,

thoughts of peace, and not of evil, to give you an expected end.”

Jeremiah 29:11

Notification and Authorization to Release Criminal
Information to FAITH Home School, Inc.

Notification

The position for which I am participating in requires me to consent to a criminal background check as a condition of volunteering/participating with FAITH Home School, Inc. This check includes the following: Criminal history reference searches for felony and misdemeanor convictions at the county and federal levels of every jurisdiction where I currently reside or where I have resided during the past 7 years; and sex offender registry searches at the county and federal levels in every jurisdiction where I currently reside or where I have resided.

Authorization

I hereby authorize FAITH Home School, Inc. to conduct the criminal background check described above. In connection with this, I also authorize the use of law enforcement agencies and/or private background check organizations to assist FAITH Home School, Inc. in collecting this information.

I also am aware that records of arrests on pending charges and/or convictions are not an absolute bar to volunteering/participating. Such information will be used to determine whether the results of the background check reasonably bear on my trustworthiness or my ability to perform the duties of my participation in a manner which is safe for FAITH Home School, Inc. students, families, and other community members.

Full Legal Name: *

Other Names You Have Used in Past Seven Years: *

Current Street Address: *

Current City, State, Zip *

Previous Address (most recent): *

Addresses in the 7 years prior to completing this authorization:

Phone Number: *

Alternate Phone Number: *

Date of Birth: * +

Gender: *

Female

Male

Have you ever been convicted of a criminal *offense or have any pending criminal* charges against you? *This refers only to felonies and misdemeanors; you do not need to include non-criminal traffic violations or municipal ordinance violations. * 🛈

Yes

If Yes Provide Detail Below

To the best of my knowledge, the information provided in this Notice and Authorization and any attachments thereto is true and complete. I understand that any falsification or omission of information may disqualify me for this position and/or may serve as grounds for the severance of my participation with FAITH Home School, Inc. By signing below I hereby provide my authorization to FAITH Home School, Inc. to conduct a criminal background check. *

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