Pathways Summer Volunteer Background Check

Pathways Summer Volunteer Program Home | Volunteer Consent to Background Check | Volunteer Reference Form

Please fill out the below form in its entirety.

I authorize Alamo Area Mutual Housing Association d/b/a Alamo Community Group (ACG) and/or its agents to make an investigation of my background, references, character, and criminal history record information which may be in any state or local files, including those maintained by both public and private organizations, and all public records, for the purpose of confirming the information contained in my application and/or obtaining other information which may be material to my qualifications for volunteering. A telephone facsimile (fax) or xerographic copy of this consent shall be considered as valid as the original consent. Prior to taking any adverse action as a result of such investigation, ACG shall provide to me a copy of the investigative consumer report which caused such adverse action and a summary of my rights under the Fair Credit Reporting Act. I release ACG and/or its agents and any person or entity which provides information pursuant to this authorization from any and all liabilities, claims, or lawsuits in regard to the information obtained from any and all of the above referenced sources.*
I authorize Alamo Area Mutual Housing Association d/b/a Alamo Community Group (ACG) and/or its agents to make an investigation of my background, references, character, and criminal history record information which may be in any state or local files, including those maintained by both public and private organizations, and all public records, for the purpose of confirming the information contained in my application and/or obtaining other information which may be material to my qualifications for volunteering. A telephone facsimile (fax) or xerographic copy of this consent shall be considered as valid as the original consent. Prior to taking any adverse action as a result of such investigation, ACG shall provide to me a copy of the investigative consumer report which caused such adverse action and a summary of my rights under the Fair Credit Reporting Act. I release ACG and/or its agents and any person or entity which provides information pursuant to this authorization from any and all liabilities, claims, or lawsuits in regard to the information obtained from any and all of the above referenced sources.
- Yes
- No
Signature*
Legal Name:*
First Middle Last
Maiden/Other Names Used:*
Dates Used:*
Present Address:*
Street Address County City State ZIP Code
Date of residence from:*
Month
Day
Year
Date of residence to:*
Month
Day
Year
Previous Address:*
Street Address County City State ZIP Code
Date of residence from:
Month
Day
Year
Date of residence to:*
Month
Day
Year
Other cities and states lived in during the past seven years:*
City: State: Date of residence from: Date of residence to:
Driver's License Number:*
*Applicant is required to provide valid photo identification (Driver’s license or state issued ID).
State of Issue:*
Date of Birth:*
Month
Day
Year
Signature:*
Date:*
Month
Day
Year

Note: The above information is required to ensure positive identification and is in no manner used as qualification for volunteering.

Pathways Summer Volunteer Program Home | Volunteer Consent to Background Check | Volunteer Reference Form

City:	State:	Date of residence from:	Date of residence to:

VOLUNTEER CONSENT TO BACKGROUND CHECK