Background Check Form

Step 1 of 3

  • Disclosure

    In connection with your application to volunteer with C3 Church NC, which may be deemed “employment purposes” under the Fair Credit Reporting Act, you may be the subject of a “consumer report” and/or an “investigative consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources such as your neighbors, friends or associates. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records (“driving records”), verification of your education or employment history, military records, professional licensure records, drug testing, or other background checks. Credit history will only be requested where such information is substantially related to the duties and responsibilities of the position for which you are applying. These reports may contain information concerning the reasons for termination of past employment. You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you, and disclosure of the nature and scope of any investigative consumer report and to request a copy of your report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for volunteer services is an investigation into your education and/or employment history conducted by SecureSearch, Consumer Disputes, 558 Castle Pines Pkwy., #B4-137, Castle Rock, CO 80108, (866) 891 – 1954,, or another outside organization. The scope of this notice and authorization is all encompassing, however, allowing the Company to obtain from any outside organization all manner of consumer reports and investigative consumer reports now and throughout the course of your volunteer service to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report.

    MAINE AND NEW YORK APPLICANTS OR VOLUNTEERS ONLY: You have the right to inspect and receive a copy of your investigate consumer report requested by [COMPANY NAME] by contacting the consumer reporting agency identified directly above directly. You may also contact the Company to request the name, address, and telephone number of the nearest unit of the consumer reporting agency designated to handle inquiries, which the Company shall provide within 5 days.

    NEW YORK APPLICANTS OR VOLUNTEERS ONLY: Upon request, you will be informed whether or not a consumer report was requested by [COMPANY NAME], and if such report was requested, informed of the name and address of the consumer reporting agency that furnished the report. By signing below, you also acknowledge receipt of Article 23‐A of the New York Correction Law.

    OREGON APPLICANTS OR VOLUNTEERS ONLY: Information describing your rights under federal and Oregon law regarding consumer identity theft protection, the storage and disposal of your credit information, and remedies available should you suspect or find that the Company has not maintained secured records is available to you upon request.

    WASHINGTON STATE APPLICANTS OR VOLUNTEERS ONLY: You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act.