Background Check Request Form

Use this form to initiate a background check per the Policy on Background Checks.

Please complete both of these steps to request a background check:

Step 1
Please fill out the form below and then click the green confirmation box below the Submit button.

Step 2
Click this link and fill out the form and then email it to: michele.king@edotn.org

You will receive a confirmation email from a member of the diocesan staff after they receive and begin to process your request. If you do not receive a confirmation email, please call the diocesan office at 817-534-1900.

Background Check Request

Subject Information

The person who needs to have a background check performed.

Name *

Address

Address

Address

Address

City

City

State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

State/Province

Zip/Postal

Zip/Postal

Phone Number *

Email Address *

Congregation * St. Martin-in-the-FieldsSt. Luke, StephenvilleSt. Luke's in the MeadowGood Shepherd, GranburyOther Congregation

Ministry Area *

Youth/Children

Vestry

Paid Staff

OtherOther

Check all that apply

Will this person drive a motor vehicle (their own or church-owned/rented) in doing their ministry/work? *

Yes or maybe

No

Indicate which level of check is required

Tier 1: Volunteers with sporadic and/or supervised access to children or youth.

Tier 2: Vestry members and other volunteers with keys to facilities and/or unsupervised access to funds or financial records.

Tier 3: Employees and volunteers with high access to children, youth, and/or vulnerable persons; persons responsible for programs for children, youth, and/or vulnerable persons.

Person submitting the request

You - the contact person at the church - not the subject of the check.

If you are human, leave this field blank.

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