Name *

First Name

Last Name

Phone *

(###)

###

####

Have you lived outside of Michigan in the last three years? *

Yes

No

Have you ever been convicted of a criminal offense, including traffic violations? *

Yes

No

Have you ever been dishonorably discharged from the military? *

Yes

No

Have you ever been accused, charged, or alleged to have committed any act of neglecting, abusing, or molesting any children? *

Yes

No

Is your first reference a staff member, elder or deacon at the church you attend? *

Yes

No

Is your second reference a staff member, elder, or deacon at the church that you attend? *

Yes

No

Consent *

We conduct criminal history checks through iCHAT, Checkr, and Michigan Depeartment of Corrections. By checking below, you authorize us to conduct such checks. Doors of Hope has permissions to make these checks as often as the organization deems necessary.

I consent to a full background check