DO NOT USE THIS FORM - Background Checks now being routed through RockRMS - contact Crystal Shelton if you need help submitting
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RELEASE AUTHORIZATION

I authorize The Cove Church to verify all data given by me on the release form below. I understand a thorough investigation may be conducted which may include but not be limited to criminal history, sex offender registries, residence verification, and motor vehicle driving record. Furthermore, I release all agencies, bureaus, information service organizations, and courts involved in this investigation from all liabilities or damages that might result from information provided in good faith. I state that the information provided by me on this form is accurate. I understand that the information requested regarding sex and date-of-birth are for the sole purpose of gathering  information accurately and will not be used to discriminate against me in violation of the law. I further understand that my background may be rerun on a regular basis if I am still employed or serving at The Cove Church. A facsimile (FAX) or photocopy of this authorization shall be as valid as the original.

Today's Date*
Today
Name (Last, First, Middle)
Maiden Name (or other names used)
Street Address
City, State, Zip Code, County
List previous address(es), other than present address, for the past seven years: street, city, state, zip
Telephone Number (cell/home)
Email
Social Security (xxx-xx-xxxx)
Date of Birth
Today
Driver's License Number / State Issued
Marital Status
Sex
Campus
Ministry Team

Answers to the following questions are not necessarily disqualifying



Have you ever been convicted of a misdemeanor other than a minor traffic offense? (Example-Driving while Impaired, Assault, Larceny) List date(s), location(s), offense(s) 

Have you ever been convicted of a felony? List date(s), location(s), offense(s)
Have you ever been convicted of a crime in a Federal Court? List date(s), location(s), offense(s)

A Note from the Cove Staff:

Statistics show that the number one way to help prevent incidents of child abuse or endangerment is the systematic use of uniform, across-the-board criminal records checks. All paid staff members have submitted to criminal record checks and it is our expectation that volunteers, will also submit understanding this is one of the steps of a comprehensive safety plan. The main goal of the safety plan is to provide the best possible protection for all minors and adults who attend The Cove Church.
Thank you!

Electronic Signature

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