If you are applying for certain positions, please note that you will need to submit your information for a background check.

Please complete the information completely.

    Please note: Areas marked with an "*" are required.

    First Name:*

    Middle Name:*

    Last Name:*

    Maiden or Other Last Name:

    Name Suffix:

    Home Address:*

    City:* State:* Zip:*

    Previous Address:*

    City:* State:* Zip:*

    Date of Birth:*

    Social Security Number:*

    Driver's License:*

    Issuing State:*

    Phone #:*

    Participant E-mail:*

    BACKGROUND AUTHORIZATION. I acknowledge that the position for which I am being considered requires me to consent to a criminal background check as a condition of volunteering. This check may include the following: criminal history searches for felonies and misdemeanors and sex offender registry searches.
    I hereby authorize Liberty Baptist Church to conduct the above mentioned checks. In connection with this, I also authorize the use of law enforcement agencies and/or private background check organizations to assist LBC in collecting this information.
    I also am aware that a criminal record is not an absolute bar to volunteering. I do understand that the information gathered will be used to help determine my trustworthiness or my ability to perform the duties of the position in in which I am applying.

    ELECTRONIC SIGNATURE AGREEMENT. By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature. By selecting "I Accept" you consent to be legally bound by these terms and conditions.


    CHECK the box IF YOU AGREE to the terms and conditions.

    My Full Legal Name - "Authorization Signature":

    Date of Agreement:*

    Please enter the letters you see in the box for verification.