The information contained in this application is correct to the best of my knowledge. I authorize any references listed in this application to give you and information (including opinions) that they have regarding my character and ability to work with children. I authorize the release of the information contained in this application to any ministry at Temple Baptist Church of Jamestown in which I seek a position. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application.
I have carefully read and understand the criminal records release (above) and consider this checkbox as my signature to authorize this release as my own free act.
I hereby request and authorize the release of any information which pertains to any record of convictions contained in the law enforcement files or in any criminal file maintained on me whether local, state or national. This information may included my driving history, including any traffic citations, a social security number verification, present and former addresses, criminal and civil history/records, and the state sex offender records.
I hereby release local, state, and national law enforcement agencies from any and all liability resulting from such disclosures.
I further acknowledge that if a criminal background check is conducted as may be required under the federal Child Abuse Prevention and Treatment Act, I may be denied access to children while the application is pending. I further understand that in accordance with this law, if I am denied a position because of a conviction which appears as a result of such a search, I may challenge such information. I understand that I am entitled to a complete copy of any background information report of which I am the subject upon my request to Temple Baptist Church, if such is made within a reasonable time from the date it was produced. I also understand that I may receive a written summary of my rights under the Fair Credit Reporting Act.
