Survey - Background Check Screening and Release

Background Check Screening and Release

Field Is Required Legal Last Name

Field Is Required Legal First Name

Field Is Required Legal Middle Name

Previous Legal Name (First, Middle Last) (Maximum response 255 chars, approx. 5 rows of text)

Dates previous legal name was used

Field Is Required Current Street Address

Field Is Required Current City

Field Is Required Current State

Field Is Required Current Zip Code

Field Is Required Date of Birth

A Social Security Number is required to process the background check. If you prefer, you may call Melissa Streit at 612-317-3417 with this information rather than providing it digitally.

Field Is Required Social Security Number (please type N/A if you will provide this information via telephone)

Field Is Required Daytime Phone

Evening Phone

Field Is Required Email (Maximum response 255 chars, approx. 5 rows of text)

Volunteer Positions Requiring Additional Checks

If your position involves driving, do you authorize a Driver's License Check?

If your position involves driving, please provide a valid driver's license number. Please also list the state if it is not a Minnesota license, (Maximum response 255 chars, approx. 5 rows of text)

If your position involves financial affairs or handling money, do you authorize a Credit Check?

Previous Background Check

Have you ever had a background check completed by the Archdiocese of St. Paul & Minneapolis (or a Catholic school or parish in the Archdiocese) within the last three (3) years?

If yes, please indicate the location where you completed a background check (site name and city):

Verification, Authorization, and Release

I verify that I have answered the above questions completely and truthfully, to the best of my knowledge. I understand that any misrepresentation or omission is grounds for rejection of my application or dismissal from the volunteer position for The Basilica of Saint Mary, hereinafter referred to as “The Organization.”

I understand and acknowledge that applications for certain volunteer positions require a personal and professional background check, and I agree to execute any and all forms required to authorize and conduct such checks.

I also understand that service is contingent upon an acceptable background check and criminal history investigation and report. I understand I will be notified if my service is terminated or denied based on the results of a background check investigation or report.

I authorize The Organization and/or The Archdiocese of Saint Paul and Minneapolis, by and through its Contracted Agents, to perform an investigation into my background and criminal history prior to and periodically during my volunteer service. If selected to serve, this authorization is valid for the duration of my service.

I hereby release the Organization, the Archdiocese of Saint Paul and Minneapolis, and its Contracted Agents from any and all liability arising from the preparation of a background report or the investigation relating thereto to the full extent permitted by law. I have read and understood this authorization and release and I am signing below voluntarily of my own free will.

Field Is Required Type your first and last name as an electronic signature

Field Is Required Date of Signature

Thank you for your participation. Please contact Melissa Streit with any questions or concerns.