Please read the form carefully and fill in the requested information. If we have any other questions after submission, we’ll be in touch. "*" indicates required fields Name* First Last Home Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Phone*Phone Type Mobile Home Landline Date of Birth* MM slash DD slash YYYY Social Security Number* Driver's License State Only required for those needing a Motor Vehicle ReportDriver's License # Only required for those needing a Motor Vehicle ReportHome Church (Name and City)* Contact at Home Church* First Last Contact at Home Church Email* Background Checks Needed* Criminal and Social Security Trace (Verified Plus) - $11.50 Credit Check - $6.75 Motor Vehicle Report - $10.15 Nominees for Ordination (Check NO Other Boxes) - $307 Criminal and Social Security Trace (Verified Plus) Price: Credit Check Price: Motor Vehicle Support Price: Nominees for Ordination Price: Payment Method*Credit CardPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Total SignatureI hereby authorize The Diocese of West Missouri, and/or its agents to make an independent investigation of my background, references, character, past employment, education, credit history, criminal, or police records, including those maintained by both public and private organizations and all public records any time while I am under the care of the Diocese of West Missouri. The purpose of this consent is to authorize the Diocese of West Missouri to confirm the information on my application for employment and/or obtain any other information relating to my qualifications for employment or volunteer service with the Diocese of West Missouri, now or at any time during the tenure of such employment or volunteer service. I release The Diocese of West Missouri and/or its agents and any person or entity, which provides information to this authorization, from any and all liabilities, claims or lawsuits in regard to the information obtained from any and all of the above referenced sources used. All information contained herein is true and correct to the best of my knowledge.Date* MM slash DD slash YYYY CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
