Background Consent


I, , hereby authorize Assemblies of God U.S. Missions 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 for the purpose of confirming the information contained on my Application and/or obtaining other information which may be material to my qualifications for U.S. Missions status now and, if applicable, during the tenure of my ministry with Assemblies of God U.S. Missions.

I release Assemblies of God U.S. Missions and/or its agents and any person or entity that 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.

The following is my true and complete legal name and all information is true and correct to the best of my knowledge:

Name:
 

Maiden Name:
 

Email:
 

Social Security Number:
 

Date of Birth:
 

Current Address:
 

Previous Address:
 

Please list below all residences where you have lived in the past five years.

Leave this empty:

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Signature Certificate
Document name: Background Consent
lock iconUnique Document ID: 85a0584b8e530701f3f9094a54eafffd3812a376
Timestamp Audit
November 18, 2021 1:55 pm CSTBackground Consent Uploaded by Trae Miller - tmiller@ag.org IP 66.119.29.16
November 18, 2021 1:55 pm CST Document owner tmiller@ag.org has handed over this document to XAAffiliations@ag.org 2021-11-18 13:55:46 - 66.119.29.16