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TLC Background Check Authorization

What's your full name?

What's a good email for you?

What other names have you used?

What is your home address?

What is your date of birth?

What is your place of birth?

What is your social security number?

Your SSN is needed for a background check. If you would prefer to send this separately, please check the box below. Otherwise, enter it here.
Untitled checkboxes field

What is your Driver's License number?

In which state was your driver's license issued?

What is the expiration date of your driver's license?

I hereby authorize The Local Church to request the Chatham County Sheriff’s Office to release information regarding any record of charges or convictions contained in its files or in any criminal file maintained on me, whether the said file is a local, state, or national file, and including but not limited to accusation and convictions for crimes committed against minors, to the fullest extent permitted by state and federal law. I do release said sheriff’s department from all liability that may result from any such disclosure made in response to this request.

I hereby authorize The Local Church to request the Chatham County Sheriff’s Office to release information regarding any record of charges or convictions contained in its files or in any criminal file maintained on me, whether the said file is a local, state, or national file, and including but not limited to accusation and convictions for crimes committed against minors, to the fullest extent permitted by state and federal law. I do release said sheriff’s department from all liability that may result from any such disclosure made in response to this request.
Signature