Night to Shine Background Check Form

I hereby authorize FIRST MISSIONARY BAPTIST CHURCH and/or its agents to make an independent investigation of my background, references, character, past employment, education, criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming my qualifications to work with individuals under 19 years of age with FIRST MISSIONARY BAPTIST CHURCH and TIM TEBOW'S NIGHT TO SHINE.  I release FIRST MISSIONARY BAPTIST CHURCH and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims, or lawsuits in regards to the information obtained from any and all of the above referenced sources used. Furthermore, by signing this form I am stating truthfully that I have never been investigated, arrested, or convicted of any crime related to children. The following is my true and complete legal name, and all information is true and correct to the best of my knowledge.

Name *
Name
Phone *
Phone
Current Address *
Current Address
Former Address *
Former Address
Date of Birth *
Date of Birth
By typing your name above you hereby authorize FIRST MISSIONARY BAPTIST CHURCH and/or its agents to make an independent investigation of my background, references, character, past employment, education, criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming my qualifications to work with individuals under 19 years of age with FIRST MISSIONARY BAPTIST CHURCH and TIM TEBOW'S NIGHT TO SHINE. I release FIRST MISSIONARY BAPTIST CHURCH and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims, or lawsuits in regards to the information obtained from any and all of the above referenced sources used. Furthermore, by signing this form I am stating truthfully that I have never been investigated, arrested, or convicted of any crime related to children. The following is my true and complete legal name, and all information is true and correct to the best of my knowledge.