Authorization for Background Check

A background check is required for anyone serving in a ministry of Strasburg Community Church that works alongside and/or with children, or pertains to the handling of money.

A guilty plea and/or conviction does not necessarily prevent you from being able to serve in a ministry of SCC. If your background check comes back with any reports, the church pastor will reach out to you to discuss it further.

Personal Information

First Name

Last Name

Email

Phone Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Gender

Birthdate

Social Security #

Drivers License #

License State of Issue

Please list any other names which you have been known by, including maiden name (last, first, middle)

Criminal History

Have you ever been convicted of or plead guilty to any criminal offense (excluding minor traffic violations)?

Yes

No

If you answered "yes" to the previous question, please briefly describe below, including details of the offense as well as any dates associated with it.

If you would like to discuss any criminal offenses/convictions in person, rather than typing it out, please select the box below.

Please contact me directly to discuss

Consent for Background Check

In connection with my volunteer service with Strasburg Community Church (SCC), I hereby authorize SCC to conduct a criminal history and child abuse background check. I understand that SCC may conduct inquiries into my background that may include criminal records, personal references, and other public reports pertaining to me.

Signature

The results of this background check will be kept confidential and only reviewed with authorized personnel.