Decatur First United Methodist Church
Volunteer Authorization for Screening and Background Check

The information contained in this application will be disclosed only to those who have a genuine need to know in order to carry out their responsibilities or as required by law.

Name *
Date of Birth *
Date of Birth
Current Home Address *
Current Home Address
Home Phone
Home Phone
Work Phone
Work Phone
Cell Phone
Cell Phone
Gender *
Marital Status *
By typing my name below, I hereby certify that the information I have provided on this application is true and correct. I understand that an investigative background inquiry may be performed on me, including, but not limited to, criminal conviction history and driving history and other such reports that may exhibit information on my character, work habits, performance, education and experience, along with reasons for termination of employment from previous employers, where such information exists. Furthermore, I understand that Decatur First United Methodist Church will be requesting information from various federal, state and other such agencies, which maintain civil history and other background. I understand that I have the right to review and challenge any negative information that would adversely impact a decision to offer volunteer work.  Under the Fair Credit Reporting Act, I understand that upon request I will be provided the name, address and telephone number of the reporting agency as well as the nature, substance and source of all information. I hereby authorize, without reservation, any party or agency contracted by Decatur First United Methodist Church, to furnish the above listed information and to release all parties involved from liability and responsibility for doing so. This authorization and consent shall be valid in online, original, fax, scan/pdf, or copy form.
Applicant Signature *
Applicant Signature
Today's Date *
Today's Date