HR - Fingerprint Background Request Form

BACKGROUND REQUEST FORM

*Background checks are only required for individuals 18 years or older

This person needing to be background checked is 18 years or older *

Yes No

Date*

Requestor Name*

First Name

Last Name

Requestor Email*

Campus*

Ministry they will be serving in *

Name of person to be background checked*

First Name

Last Name

Email of person to be background checked*

Phone of person to be background checked *

Their position title will be*

Role of person to be background checked*

Role Description*

No File Chosen

File uploads may not work on some mobile devices.

Start Date*

End Date*

Administrative Needs (check all that apply)*

Name Tag ID Badge Real Life Email Planning Center Access Added to Workplace

Upload Photo

No File Chosen

File uploads may not work on some mobile devices.

Notes

Please note that we will make up to three attempts to contact the individual requiring a background check. If there is no response, the request will be denied, and you will receive notification. It will then become your responsibility to verify the contact information and resubmit the request if necessary.*

I understand and agree