Name(Required) First Middle Last Please provide any previous names/maiden names or nicknames that have been associated with your name.(Required)Current Home Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Street Address Only. No P.O. BoxPrevious Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Street Address Only. No P.O. BoxHow long have you lived at your current address?(Required)Date of Birth(Required) MM slash DD slash YYYY Crimcheck.com will only use this information for background screening purposes and no other purpose.Driver's License #(Required)Driver's License State(Required)Social Security Number(Required)Email(Required) Acknowledgement & Authorization of Background Check.(Required) By signing below, I authorize The Church of God (“Employer”) to obtain “consumer reports” and/or “investigative consumer reports” about me during the course of the application process and during the course of my employment, to the extent permitted by law. You have the right, upon written request made within a reasonable amount time after the receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report by contacting Crimcheck.com 17295 Foltz Industrial Parkway, Suite B, Strongsville, OH 44149 [1-877-992-4325].Disclosure of Background check to be conducted on you. In connection with your application and/or employment with The Church of God (“Employer”) this notice is provided to inform you that a “consumer report” and/or “investigative consumer report”, as defined by the Fair Credit Reporting Act, may be obtained from a consumer reporting agency for employment purposes. These types of reports may include information as to your character, general reputation, personal characteristics, and mode of living, whichever are applicable. The report(s) may also contain information about you relating to your criminal history, credit history, driving and/or motor vehicle records, verification of your education or employment history and other background checks. They may involve interviews with sources such as your neighbors, friends, or associates.Signature(Required)
