Mentor Background Check Permission Form

Thank you for your interest in mentoring with our nonprofit organization. To ensure the safety of our participants, we require all mentors to complete a background check. Please fill out this form to authorize us to conduct the necessary checks.

Personal Information

Full Name

Date of Birth

Social Security Number

Current Address Phone Number Email Address

Background Check Authorization

I hereby authorize [Organization Name] to conduct a background check, including criminal history, and to verify the information provided above as it relates to my application to become a mentor. I understand that the results will be kept confidential and used for volunteer screening purposes only.

Signature

Date

Additional Comments (optional)