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.
 

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Your legal name

Your email address

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Signature Certificate

Document name: Background Consent 2022

Unique Document ID: 62a1b58e46bb8719c9e301e37a7603ec32cf0a57

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Timestamp	Audit
November 18, 2021 1:55 pm CDT	Background Consent 2022 Uploaded by Chi Alpha Affiliations - [email protected] IP 66.119.29.16
November 18, 2021 1:55 pm CDT	Document owner [email protected] has handed over this document to [email protected] 2021-11-18 13:55:46 - 66.119.29.16

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