Background Check Consent Form

Background Check Information

This information is required to run a thorough background check on member applicants.

Yost Lake Country Club Backround Check Consent Form
Applicant Name*

First

Last
Applying For*
- Member
- Employee
- other
Social Security Number*
Date of Birth*

Month

Day

Year
Address*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Consent*
I consent to this background check
I authorize and give consent for Yost Lake Country Club to obtain information regarding myself. This includes the following:
- Criminal background records/information
- Sex Offender Registry Checks
- Addresses
I the undersigned, authorize this information to be obtained either in writing or via telephone in connection with my volunteer application. Any person, firm or organization providing information or records in accordance with this authorization is released from any and all claims of liability for compliance. Such information will be held in confidence in accordance with the organization’s guidelines.
Name*

First

Last
Todays Date*

MM slash DD slash YYYY
Digital Signature
I agree to use this as my digital signature
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