Consent for Background Check

"*" indicates required fields

Your signature below authorizes South Spring Baptist Church Tyler, TX and One Source The Background Check Company to obtain information about you from various law enforcement agencies, courts, and corrections agencies. SSBC has requested not to receive any consumer and/or credit information, only information that pertains to criminal background.

Full Legal Name*

First Last

Email*

Phone*

Gender*

Male

Female

Current Address*

Street Address Address Line 2 City State ZIP Code

Other Names Used

(Maiden, alias’, legal name change, etc.)

Date of Birth*

Social Security Number*

Driver's License Number

State*

Previous addresses in the past 7 years:

Have you ever been convicted of a crime?*

Yes

Please explain:

Applicant’s signature: I have reviewed and completed this form as applicable to me. I give South Spring Baptist Church Tyler, TX permission to verify any information I have provided. This authorization shall continue to be effective until revoked by me. A photocopy or facsimile copy of this consent shall be as effective as the original. By my signature, I affirm that all information on this form is true and accurate.

Signature:*

Date*

Comments

This field is for validation purposes and should be left unchanged.

(903) 839-0111

info@southspring.org

Consent for Background Check