Background Check Request Form

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

When your entered information is submitted correctly, you will see a green confirmation box below the Submit button. 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 Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

State/Province

Zip/Postal

Zip/Postal

Phone Number *

Email Address *

Congregation * St. Martin-in-the-Fields St. Luke, Stephenville St. Luke's in the Meadow Good Shepherd, Granbury Other 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.