Concordia Lutheran Background Check Form
This background check is for employment purposes
This background check is for volunteer purposes (within the church)
Please list the areas in which you wish to serve the church:
This background check is for volunteer purposes (within the school)
Please list the name of your student(s) currently enrolled in Concordia Lutheran School:
Please list the areas in which you wish to serve the school:
First name
*
Middle name
*
Last name
*
Maiden name
*
Aliases
Birth date
*
SSN Last 4
*
Drivers License State
*
Drivers License Number
*
Current address
*
Have you lived anywhere else in the past 5 years?
*
Yes
No
Previous address #1
Check this box if you need to add an additional address
Previous address #2
Check this box if you need to add an additional address
Previous address #3
I hereby request and authorize the release of any information that pertains to any record of convictions contained in law enforcement files or in any criminal file maintained on me whether local, state, or national. I hereby release local, state, and national law enforcement agencies from any and all liability resulting from such disclosure. I further acknowledge that if a criminal background check is conducted, as may be required under the federal Child Abuse Prevention and Treatment Act, I may be denied access to children while the application is pending. I further understand that in accordance with this law, if I am denied a position because of a conviction that appears as a result of such search, I may challenge such information.
Today's date is: Dec 3, 2024
I understand that this Background Authorization is valid for 1 year: