Volunteer Police Check Information

 

In light of the society we live in, we, as a church are seeking to do all we can to protect the young people that we minister to in every way possible. This volunteer police check enables us to maintain the highest possible standards of integrity in our relationships with parents, volunteers, school administrators, and others from the community who we reach out to with God’s love. Your signature attests that you have not committed any criminal sexual offenses and authorizes the screening process. Please be assured that all records are kept confidential and that only sexual charges or felony convictions are seen as possible disqualification for ministry. Thank you for all the ways that you help us reach Holland and beyond for the glory of God. Your impact as a volunteer is highly valued.

 

Signature

Yes. I agree to a Police Background Check on myself.

 

Full Legal Name

 

Date of Birth
(MM/DD/YYYY)

Date of Birth :: MM/DD/YYYY

 

Ethnicity Choose Ethnicity White / Caucasian Black / African American Hispanic Asian / Pacific Islander Arabic / Middle Eastern Native American Indian

 

Gender

Male Female

 

A copy of the front and back of your drivers license is required. Please upload electronically or fax it to 616-395-3153.

 

Drivers License

Drivers License :: 4 MB Max. doc, jpg, pdf

 

Previous Last Name

 

As an adult, have you ever lived outside of Michigan?

 

residence

Yes No

 

If yes, then please provids details:

Residency1

What year: Enter a Year :: YYYY

To What year: Enter a Year :: YYYY

Where?

[Add Line] ->

Residency2

What year: Enter a Year :: YYYY

To What year: Enter a Year :: YYYY

Where?

[Add Line] ->

Residency3

What year: Enter a Year :: YYYY

To What year: Enter a Year :: YYYY

Where?

 

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