Oklahoma Conference of Seventh-day Adventists Oklahoma City, Ok OK : Inquiry Release Form

Oklahoma Conference of Seventh-day Adventists and Secured Personnel Data

INQUIRY RELEASE FORM

In connection with my application for employment or continued employment (as well as contracted services) with you, I understand that investigative background inquiries are to be made on myself including criminal convictions, motor vehicle, and other reports. These reports will include information as to my character, work habits, performance and experience along with reasons for termination of past employment from previous employers. I understand that you will be requesting information from various Federal, State, and other agencies which may maintain records concerning my past activities relating to my driving, criminal and civil experiences.

I authorize without reservation, any party or agency contacted by this employer or its agent to furnish the above mentioned information. By granting this release for obtaining information, I understand that I will be given opportunity upon my request to review with the employing agent the resulting information that is placed in my personnel file and that the related information will be treated with appropriate confidentiality.

I hereby consent to your obtaining the above information from Secured Personnel Data, Inc., and/or any of their licensed agents, through the Oklahoma Conference of Seventh-day Adventists. I understand that to aid in the proper identification of my file or records the following information, as well as other information, is necessary.

* I agree to the previous stated terms.

PERSONAL INFORMATION:

First Name:

Middle Name:

Last Name:

Maiden Name:

Prospective Employer:

* (Local School or Church)

Prospective Position:

SSN

* (xxx-xx-xxxx)

DOB:

* (xx-xx-xxxx)

Sex:

* (M or F)

Race:

Drivers license number:

Drivers license state issued by:

Have you ever been convicted of a felony?

Of a misdemeanor
(Other than traffic violations)?

Felony / Misdemeanor Explained

Telephone:

^* (xxx-xxx-xxxx) Day

^*(xxx-xxx-xxxx) Evening

Email:

Verify Email:

WORK HISTORY:

Employing Organization 1:

^* (Not Oklahoma Conference)

Current Position:

Dates (from when to when):

^* (From 01/08 to 01/09)

Address:

Address (continued):

County:

City:

State:

Zip:

Phone:

^* (xxx-xxx-xxxx)

Employing Organization 2:

Former Position:

Dates (from when to when):

Address:

Address (continued):

County:

City:

State:

Zip:

Phone:

Employing Organization 3:

Former Position:

Dates (from when to when):

Address:

Address (continued):

County:

City:

State:

Zip:

Phone:

Employing Organization 4:

Former Position:

Dates (from when to when):

Address:

Address (continued):

County:

City:

State:

Zip:

Phone:

Applicant's Signature:

* Date: *

* Enter the code in the graphic below to help eliminate spam entries.

^*denotes required field.