All information submitted below will be used solely for the purposes of the criminal background history check.
Authorization/Waiver/Indemnity
Each Disciple Central Community Church (DC3) employee and/or ministry staff/volunteer member must be screened and must sign an authorization/waiver/indemnity form giving approval for DC3 to perform a criminal background search.
I hereby give my permission to DC3 to obtain information relating to my criminal history record through the Dallas County District Attorney’s Office. The criminal history record, as received from the reporting agencies, may include arrest and conviction data as well as plea bargains and deferred adjudications and delinquent conduct as committed as a juvenile. I understand that this information will be used, in part, to determine my eligibility for an employment and/or ministry staff/volunteer position with DC3. I also understand that as long as I remain an employee or ministry staff/volunteer member with DC3, the criminal history records check may be repeated at any time. I understand that I will have an opportunity to review the criminal history as received by DC3 and a procedure is available for clarification, if I dispute the record as received. I also understand that the criminal history could contain information presumed to be expunged.
I, the undersigned, do, for myself, my heirs, executors and administrators, herby remise, release and forever discharge and agree to indemnify and hold harmless DC3 and each of their officers, directors, employees and agents from and against any and all causes of actions, suits, liabilities, costs, debts and sums of money, claims and demands whatsoever (including claims for negligence, gross negligence, and/or strict liability of Disciple Central Community Church and any and all related attorneys’ fees, court costs and other expenses resulting from the investigation of my background in connection with application to become an employee or ministry staff/volunteer member.