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Church Background Check Form

A form churches and ministries use to gather a candidate's personal and legal history before confirming them as a volunteer or staff member who will work with the congregation.

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Applicant Name

Nombre

Apellido

Phone Number

Address

Dirección

Ciudad

Estado / Provincia

Código postal

Place of Birth

Gender

Male Female Other

Race

Driver's Security Number

State

Do you have a photo ID?

Yes No

Emergency Contact Name

Nombre

Apellido

Emergency Contact Phone Number

Section

Have you ever been convicted or plead guilty before a court for any federal, state or municipal criminal offense? (Excluding minor traffic misdemeanors).

Yes No

Please provide

Nombre

Apellido

Date of Offense

Details of Conviction

Have you ever received deferred adjudication or similar disposition for any federal, state or municipal offense?

Yes No

Please provide

Nombre

Apellido

Date of Offense

Details of Conviction

Have you ever received probation or community supervision for any federal, state or municipal offense?

Yes No

Please provide

Nombre

Apellido

Date of Offense

Details of Conviction

Have you ever been convicted of any criminal offense in a country outside of the jurisdiction of the United States?

Yes No

Please provide

Nombre

Apellido

Date of Offense

Details of Conviction

As of the date of this consent form, do you have any pending charges against you?

Yes No

Please provide

Nombre

Apellido

Date of Offense

Details of Conviction

Section

I, the applicant, agree with the following statement:

I certify that all information provided in this application is true and accurate to the best of my knowledge.

Date

Signature of Applicant

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