Candidate Authorization Form
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Background Investigation Consent

Instructions: Insert candidate's name in first blank on line 1. Insert legal name of church or ministry in the remaining blanks, including in the note at the bottom of the page. Applicant should complete all relevant information and sign and date the form.

I, ______________________________________, hereby authorize ________________________________________and/or its agents to make an independent investigation of my background, references, character, past employment, education, credit history, criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my Application and/or obtaining other information which may be material to my qualifications for employment now and, if applicable, during the tenure of my employment with _______________________.

I release ___________________________ and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the information obtained from any and all of the above referenced sources used.

The following is my true and complete legal name and all information is true and correct to the best of my knowledge:

Full Name (Printed)_______________________________________________________

Maiden Name or Other Names Used_________________________________________

Present Address_________________________________________________________

How Long at Present Address?_____________________________________________

City______________________________________State__________Zip____________

Former Adrress__________________________________________________________

City______________________________________State__________Zip____________

How Long at Former Address?______________________________________________

Date of Birth*: _________________________________________________________

Social Security Number: __________________________________________________

Driver's License Number: __________________________________________________
State of License: __________

______________________________________________________________________
Signature of Candidate / Date

*NOTE: The above information is required for identification purposes only, and is in no manner used as qualifications for employment. _____________________________________________ abides by all applicable state and federal employment laws.