CRCC Background Check

If you would prefer to fill out a paper copy of the background authorization form, please print a copy of the from by going to www.crcc.com or requesting the from at the Church office. Your background authorization must be completed annually and 14 days prior to the first event you serve at.

Name

Phone

This address will receive a confirmation email

Where will you be serving? (click all that apply)

AWANA Babysitting Children's Ministry Solid Rock Christian Preschool & Kindergarten Youth Ministry Solid Rock Christian Homeschool Co-op

Today's Date

Birthdate

Have you ever been: Convicted on any crime against children or other persons?

Yes No

Convicted of crimes relating to financial exploitation if the victim was a vulnerable adult?

Yes No

Convicted of crimes related to drugs as defined in RCW 43.43.830?

Yes No

Found in any dependency action under RCW 13.34.040 to have sexually assaulted or exploited any minor or to have physically abused any minor?

Yes No

Found in any disciplinary board final decision to have sexually or physically abused or exploited any minor or developmentally disabled person or to have abused or financially exploited any vulnerable adult?

Yes No

Found by a court in a protection proceeding under chapter 74.34 RCW, to have abused or financially exploited any vulnerable adult?

Yes No

To ensure both your safety and the safety of the children in your care, please speak with a Ministry Staff Member if you have concerns or special needs related to HIV/AIDS, blood disorders, or hepatitis. Thank you

Digital approval to run a background check

Yes No

Applicant's Statement:
The information contained in this application is correct to the best of my knowledge. I authorize any references, churches, or other organizations listed in this application to give you any information they may have regarding my character and fitness for children's/minor's services, and I release all such references from liability for any damage which may result from furnishing such evaluations to you. I understand the personal information will be held confidentially by the professional chruch staff. I also understand that there will be a background check conducted.

*Your Electronic Signature and Submission authorizes a background check

Electronic Signature Required

For CRCC Staff Only

Date Completed by CRCC Staff

CRCC Background Check

Description

Please Fix the Following