Please provide Name, Contact Info, How long you've known the reference, and How do you know them
Please provide Name, Contact Info, How long you've known the reference, and How do you know them
Authorization/Consent
During the application process and at any time during the tenure of my employment/service with
Broadway Christian Church, I hereby authorize ChoicePoint Services Inc., on behalf of Broadway Christian
Church to procure a consumer report (known as an investigative consumer report in California) which I
understand may include information regarding my character, general reputation, or personal
characteristics. This report may be compiled with information from courts record repositories,
departments of motor vehicles, past or present employers and educational institutions, governmental
occupational licensing or registration entities, business or personal references, and any other source
required to verify information that I have voluntarily supplied. I understand that I may request a complete
and accurate disclosure of the nature and scope of the background verification; to the extent such
investigation includes information bearing on my character, general reputation, or personal
characteristics.
BACKGROUND VERIFICATION DISCLOSURE
This is used to inform you that a consumer report is being obtained from a consumer reporting agency for
the purpose of evaluating you for employment, volunteer service or a contracted position, including
retention as an employee, volunteer or independent contractor.
This report may contain information bearing on your character, general reputation, and personal
characteristics from public or private record sources.
I release Broadway Christian Church and/or its agents and any person or entity, which provides
information pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the
information obtained from any and all of the above referenced sources used.
The following is my true and complete legal name and all information is true and correct to the best of my
knowledge:
