Background Check Form in Word[1]Information)&)Background)Check!!!!! All#volunteers#working#in#any#capacity#at#Compass#Christian#Church#must#consent#to#a#...

Volunteer  Information  &  Background  Check          

All  volunteers  working  in  any  capacity  at  Compass  Christian  Church  must  consent  to  a  Background  check.    Please  complete  this  form  in  BLACK  or  BLUE  INK  and  return  to  Compass  Christian  Church  by  fax  (817-­‐906-­‐1484)  or  mail  (2600  Hall  Johnson  Rd.,  Colleyville  TX  76034).      This  form  must  be  filled  out  completely  including  signature  of  consent.      Campus  you  desire  to  serve:                        _______  Colleyville                                            _______Roanoke              Legal  name:          First_______________________________Middle_________________________Last___________________________________________    Maiden  name,  if  applicable:______________________________________________                (circle)  Male  /  Female            Social  Security  Number  :__________________________________________________          (kept  secured)      Birth  date:  ___________________    Home  Phone  #____________________________    Cell  #____________________________      Address:_______________________________________________  City:  _______________________________    Zip:  ______________    E-­‐Mail  Address:_________________________________________________________________________________________________    How  long  have  you  attended  Compass?___________  Are  you  an  immersed  believer  in  Christ?  _______      Ministry  for  which  you  are  volunteering:_________________________________________________________________                 example:  Children;  Youth;  VBS;  Fall  Event;  Adult  Ministry;  Worship  Arts;  etc.    Counties  and  States  where  you  have  resided  in  the  past  5  years:_____________________________________      Have  you  at  any  time  ever:  Been  arrested,  convicted,  or  pleaded  no  contest  to  any  crime,  other  than  a  traffic  violation?  ____Yes  ___No      In  the  past  year,  have  you  been  cited  for  a  traffic  violation?      ____Yes  ____No            Engaged  in,  or  been  accused  of,  any  act  of  child  abuse,  molestation,  or  exploitation?      ____Yes  ____No      If  yes,  please  explain:  __________________________________________________________________________________________________________      ________________________________________________________________________________________________________________________________________      ________________________________________________________________________________________________________________________________________      

1.    Name_________________________________________________  Address______________________________________________________                City______________________________  State_____________  Zip____________      Phone    Number_____________________________                E-­‐Mail  Address________________________________________  How  do  you  know  this  person?__________________________                _______________________________________________________________________________________________________________________            How  long  have  you  known  this  person?  __________________________________________________________________________      EMAIL  ADDRESS  REQUIRED.  Please  advise  reference  they  WILL  be  contacted  via  email  and  encourage  them  to  respond  as  soon  as  possible.    Background  Checks  cannot  be  completed  without  2  references  on  file.  

If  you  have  not  previously  filled  out  a  background  check  for  Compass,  please  list  two  individuals  who  can  testify  to  your  character  and  suitability  for  working  with  children  or  youth  or  in  any  ministry  of  the  church.      

2.    Name_________________________________________________  Address______________________________________________________                City_______________________________  State_____________  Zip____________    Phone  Number_____________________________                E-­‐Mail  Address________________________________________  How  do  you  know  this  person?__________________________                _______________________________________________________________________________________________________________________            How  long  have  you  known  this  person?  __________________________________________________________________________      EMAIL  ADDRESS  REQUIRED.  Please  advise  reference  they  WILL  be  contacted  via  email  and  encourage  them  to  respond  as  soon  as  possible.    Background  Checks  cannot  be  completed  without  2  references  on  file.  

References  must  be  18  years  or  older  and  cannot  be  related  to  you.  

Please  read  and  SIGN  below:  

CONSENT  TO  RUN  BACKGROUND  CHECK  

“The  above  information  is  true  to  the  best  of  my  knowledge.  I  understand  and  agree  that,  to  the  extent  permitted  by  Texas  Law,  Compass  Christian  Church  may  secure  criminal  history  information  about  me.    I  am  a  committed  Christian,  and  I  will  do  my  best  to  conduct  myself  in  a  manner  as  to  cause  no  question  to  the  name  of  Jesus  Christ  or  to  the  ministry  of  Compass  Christian  Church.”  

Signature:  ____________________________________________________            Date:  _____________________________          Office  Use:    Tag  Added:  ___________      References  checked  by:  _____________    Background  Checked  by:_____________