Background Check Form "*" indicates required fields Step 1 of 3 33% Full Legal Name: First Middle Last I have no legal middle name.* I have no legal middle name Other Names Used* Check this box to enter any other legal names you have used, such as your maiden name. Date of Birth: MM slash DD slash YYYY Email Address:* Enter Email Confirm Email Social Security Number*Gender:* Female Male Telephone:*Driver's License Number:* Select State:*AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificCurrent Address:Since:* MM slash DD slash YYYY Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code I have provided all US based addresses for past 7 years I have provided all US based addresses for past 7 years What is the best way to contact you?* Text Phone Email What is the best time to contact you? (i.e. Mondays, 2-5)* What is you age group?*Under 1818-2526-3536-4546-5555+What areas of ministry are you interested in serving in?* First Impressions (Greeter Usher Parking Hospitality (Cafe) Kids Men Office Tech/Production Women Worship Youth Other Questions/CommentsChildren QuestionsAs an organization we are concerned about our children and students and their well being. Is there anything in your past or present that would prohibit you from effectively working with children and/ or students?* Yes No By checking the 'I agree' box and entering my full name I recognize that this is equivalent to my legal signature.* By checking the ‘I agree’ box and entering my full name I recognize that this is equivalent to my legal signature. Name: First Middle Last Date:* MM slash DD slash YYYY FCRA Notice – Background InvestigationIn connection with your volunteer application with Grace Point Fellowship (the “Church”), please note that we will be obtaining a consumer report from a consumer reporting agency for screening purposes. This report may include information about you relating to your criminal history, driving and/or motor vehicle records, social media or other background checks. I Agree I Disagree * THIS ONLINE APPLICATION IS PROTECTED BY A SECURE CERTIFICATE AUTHORITY, WHICH SUPPORTS UP TO A TLS1.2 256-BIT ENCRYPTION PROCESS. THIS PROCESS CAN BE VERIFIED USING YOUR BROWSER’S SECURITY CERTIFICATE INFORMATION PAGE. ALL INFORMATION PROVIDED ON THIS FORM IS SECURE. FOR MORE INFORMATION ON HOW TO ACCESS THIS INFORMATION, PLEASE CONTACT US.