Volunteer Background Check Consent Form

Your Information

First Name *

Last Name *

Email Address *

Phone Number

Volunteer Background Check- Consent Form & Application

APPLICATION & CONSENT TO PERFORM CRIMINAL HISTORY BACKGROUND CHECK

Full Legal Name *

Please include first, middle and last name

Maiden and/or other Last Names used

DOB *

* Date Of Birth MM/DD/YYYY

SSN *

Driver's License Number *

Driver's License State *

Gender *

Ethnicity *

Race *

Street Address *

City, State, Zip Code *

Phone Number *

Phone number must be 10 digits

Have you ever been convicted or plead guilty before a court of any federal, state, or municipal criminal offense? (excluding minor traffic violations)? *

Yes
No

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

Yes
No

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

Yes
No

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

Yes
No

As of the date of this authorization, do you have any pending criminal charges against you? *

Yes
No

I am applying to volunteer with ATX KIDS CLUB and have been advised that as a part of the application process, the employer conducts a criminal history background check. I do hereby consent to the employer use of any information provided during the application process in performing the criminal history check. I understand that if I conceal prior convictions or provide incorrect information, the organization has a right to terminate my volunteering immediately. Please type your name as your signature for this consent for. By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature. *

Additional Volunteer Information

Provide any volunteer and/or experience working with children *

How did you learn about ATX KIDS CLUB? *

Your Information

Volunteer Background Check- Consent Form & Application

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