Skip to content
A Voice of Love and Hope for Those with Disabilities
Summer Day Camps
School Year Events
Our Mission and Vision
Summer Staff Background Check
Background Record Check Release - Staff
All items are REQUIRED.
We'll notify you by email that we successfully received your form...
Address Line 2
District of Columbia
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Social Security Number
(format is: ###-##-####)
Date of Birth
Do you have a driver's license?
Driver's License Number
License Issued in What State (ex: KS)?
Authorization for Background Check
I authorize the investigation of any or all statements provided during the process of this application, and I hereby release said organization from all liability for any damages for issuing this information concerning my background. I authorize the investigation of any or all statements provided during the process of this application, and I hereby release said Organization from all liability for any damages for issuing this information concerning my background Records.
I understand and agree that in the event I am offered an opportunity to serve, it is contingent upon my passing criminal background checks, the sexual offender registry check, and any other screening tests as may be required. I agree to consent to those checks at such time as designated by the Organization and to release the Organization, its directors, officers, agents or employees from any claim arising in connection with the use of such background checks.
Select Today's Date
I'm applying for Champions Camp Staff. I have read and understand the Authorization statement above, and I hereby authorize Champions Special Ministries to conduct a required legal Background Check using my name, address, SSN, Driver's License info, and date of birth. (Add your signature using your mouse or touchscreen.)