Background Check - Sacred Heart Catholic School

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Criminal Background Search Authorization & Release Form

CRIMINAL BACKGROUND SEARCH AUTHORIZATION & RELEASE FORM

PLEASE SUBMIT A COPY OF THE FRONT AND BACK OF BOTH YOUR SOCIAL SECURITY CARD AND GOVERNMENT ISSUED I.D.

WITHOUT BOTH AND/OR EITHER APPLICATION IS ILLEGIBLE FOR PROCESSING.
First Name, Middle Name, Last Name
Other names used in the past five years:
Current Address
Address 1
Address 2

City

State

Zip
Work Phone #
Home Phone #
Email Address
Date of Birth
Gender
Driver's License Number
Name of Parish, School, Agency:
Name of Volunteer Position or Job Title with Parish, School, Agency:
Will this position require you to work or volunteer consistently with minors?
Yes No

Have you ever been convicted of, arrested for, charged with, placed on probation for, granted deferred adjudication for an/or given any pretrail diversion for any violation of the law?

You do not need to disclose minor traffic violations.
Yes No
If answered "yes", give full details of the event(s).
Please read the following paragraph carefully and electronically sign below to indicate that you understand this document:

I hereby authorize the Archdiocese of San Antonio, and its agent(s), to request and receive any and all background information from Texas Department of Family and Protective Service and my driving record.

I understand that background information received from reporting agencies, may include arrests, convictions, plea bargains, deferred adjudications, delinquent conduct committed while a juvenile, expungent and investigations.

I further release the Archdiocese of San Antonio and its agents, employees, personnel or representative from any and all claims and liability arising out of the request for this information.

I certify that I can be trusted with the supervision, guideance, education and/or care of minors and/or vulnerable adults and that I will abide by the policies and procedures of the Archdiocese of San Antonio, of which I have been fully informed.

The statements made by me on this form are true, correct, accurate and complete and are made in good faith.

I understand that any false statements made on this form may results in the denial of the application, termination of employment, suspension of volunteer services, and/or other disciplinary action.
Front and Back of Government Issued I.D. *

(allowed file types: doc, docx, jpeg, jpg, pdf, txt)
Front and Back of Social Security Card *

(allowed file types: doc, docx, jpeg, jpg, pdf)
Electronic Signature *
Date *
Enter Your Email Address: *