AUTHORIZATION FOR RELEASE OF INFORMATION

By completing and submitting this form in connection with your application for volunteer service with Church 2:14, you authorize Church 2:14, to solicit background information relative to your criminal record history. Church 2:14 may conduct inquiries into your background that may include criminal records, personal references and other public record reports pertaining to you.

Electronic submission of this form confirms your agreement of the following:

I authorize without reservation, any person, agency, or other entity contacted by Church 2:14, for purposes of obtaining background report information to furnish the above-mentioned information.

I release Church 2:14, their respective employees, agencies and entities providing information or reports about me from any and all liability arising out of furnishing any such information or reports.

Legal Name

First Name

Last Name

Middle Name

Maiden Name

Email Address

Phone number

Date of Birth

YYYY

SSN

City / County / State of Birth

Current Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country