Fill and Sign the Permission Check Background Form

PERMISSION TO CHECK BACKGROUND INFORMATION I,       , hereby grant permission to       and its representatives to undertake a credit check or other verification of the foregoing information. I understand that any information obtained will be for the purpose of gaining admission into       and will be held in strict confidence. Any information gathered will be shared only with those individuals necessary to make a decision pertaining to my admission into the aforementioned organization. I understand that granting permission to do a background check does not cause either party to incur any obligations, nor does it guarantee membership. I understand that said organization is relying in part upon the information that I have provided and contained herein to determine whether I am qualified for membership, and that all of the representations contained herein are true. Upon acceptance to said organization, all dues and fees are non-refundable. Name:       Address:       City:       State       Zip:       Phone:       (w)       (c)       Church:       Employment:       Years:       Previous Employment:       Years:       SSN:       School:       Organizations:       Do you know any members? Yes No If yes, whom do you know?       Have you ever been arrested? Yes No If yes, what happened?       Were you charged? Yes No Why do you want to join our organization?       ____________________       Signature Date Copyright 2004 USLegalforms.com