Background Check Authorization — Sovereign Grace Church of Pasadena

CONFIDENTIAL RECORD

Name

First Name

Last Name

Former Names

First Name

Last Name

Email

*Social Security #

First Name

Last Name

Current Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Previous Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth

MM

DD

YYYY

Phone

(###)

###

####

Email

ACKNOWLEDGMENT

The information contained in this authorization is correct to the best of my knowledge. I hereby authorize Sovereign Grace Church of Pasadena and its agents and representatives to conduct a criminal background check as a prerequisite for a service position in the SGC Children's Ministry program.

Name

First Name

Last Name

Date

MM

DD

YYYY

* Social Security numbers are used to verify identification only and will not be kept on file once a criminal background check has been obtained.