References & Background Checks

References: Please list three references with complete address and phone numbers, who are familiar with your character, especially as it relates to working with children.  References will be checked.  Please do not list Alliance Bible Church staff or your relatives.

 

My Name: *
First Name
Middle
Last Name
First Reference Name:*
Address: *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Phone Number:*
Email:*
2nd Reference Name:*
Address: *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Phone Number:*
Email:*
3rd Reference Name:*
Address: *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Phone Number:*
Email:*
I agree to a criminal background check to be run on my name. I hereby request and authorize information which pertains to any record of convictions contained in the files, or in any criminal file, maintained on me whether local, state or national. I hereby release local, state, and national law enforcement agencies from any and all liability resulting from such disclosure.*
Birthdate (Month/Day/Year):*
Social Security Number:*
Full Name: *
First Name
Middle
Last Name
All Aliases:
Driver's License #:
Issuing State of License:
By typing my signature, I confirm that all the above information is accurate:*
Date:*
**For applicants under the age of 18** Parent Signature - by typing my signature, I'm confirming that the above information is correct for my son/daughter:
Date: