Background Check Form

2024 BACKGROUND CHECK FORM

I. I understand that a criminal background check report will be generated on me that may include information such as: past criminal activities; court decisions or convictions for all infractions, misdemeanors, and felonies; corrections/incarceration records, and other character-related information and history. I also understand that backgroundchecks.com, on behalf of the Romanian-American Mission (RAM) may request information from public and private sources about me so as to allow a thorough screening and consideration of me as potential volunteer worker with minors with RAM. I give my full consent for this information to be obtained.

II. I acknowledge that a facsimile (FAX) or photographic copy of this release shall be as valid as the original. This release is valid for most federal, state and county agencies.

III. I hereby authorize, without reservation, any law enforcement agency, information service bureau, school, employer, or insurance company
contacted by backgroundchecks.com to furnish the information described in Section I, (Juvenile Records (under age 17) exempted).

IV. Communications with backgroundchecks.com should be directed to P.O. Box 353; Chapin, South Carolina 29036 or to their phone number 866-265-6602.

I agree and I sign

Date

1. NAMES

Please type your name as it appears on your passport

First Name

Middle Name (if any)

Last Name

Maiden Name

Other Names Used

2. ADDRESSES

CURRENT ADDRESS

Street Address

Street Address Line 2

City

State/Province

Postal / Zip code

Date when you moved to this address

PRIOR ADDRESS #1

Street Address

Street Address Line 2

City

State/Province

Postal / Zip code

Date when you moved to this address

PRIOR ADDRESS #2

Street Address

Street Address Line 2

City

State/Province

Postal / Zip code

Date when you moved to this address

3. PERSONAL INFORMATION

The following information is required by law enforcement agencies and other entities for positive identification purposes when checking public records. It is confidential and will not be used for any other purposes.

Date of birth

Social Security Number

Gender

Male

Female

Driver's License Number

Name as Listed on Driver's License

Name as Listed on Passport

Have you ever been convicted of a crime?

Yes

If yes, please provide city and state of conviction and details of conviction

FAIR CREDIT REPORTING ACT NOTICE
In accordance with the Fair Credit Reporting Act (FCRA, Public Law 91-508, Title VI), this information may only be used to verify a statement(s) made by an individual in connection with legitimate business needs. The depth of information available varies from state to state. Status of updates are available on request. Although every effort has been made to assure accuracy, backgroundchecks.com cannot act as guarantor of information accuracy or completeness. Final verification of an individual’s identity and proper use of report contents are the user's responsibility. backgroundchecks.com’s policy requires purchasers of these reports to have signed a Service Agreement. This assures backgroundchecks.com that users are familiar with and will abide by their obligations, as stated in the FCRA, to the individuals named in these reports. If information contained in this report is responsible for the suspension or termination of an employee or the application process, the Candidate/employee may contact backgroundchecks.com.

BY SIGNING BELOW, I AM DECLARING THAT ALL THE INFORMATION I ENTERED ABOVE IS TRUE.

I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THIS ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

I declare that all the information is true and I sign

Date

Thank you! Your background check form was submitted successfully!