Background Check Authorization Form

Please select one of the following:

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: Oct 18, 2021

I understand that this Background Authorization is valid for 1 year: