Crossroads Community Church - California

Thank you for serving our children and youth with love and dedication in the name of Jesus.
In order to stay in compliance with California State Law, we are all required to complete the waiver form below. This will meet the annual Live Scan/Criminal History reporting so you can continue in your role of helping our kids follow Jesus.
Please take 90 seconds or less to complete the form now! And don't forget to click SUBMIT at the end! Thank you!
Let us know if you have questions!

STATE OF CALIFORNIA
BCIA 9018
Department of Justice

CalVECHS WAIVER AGREEMENT
FOR RELEASE OF CRIMINAL OFFENDER RECORD INFORMATION

Pursuant to the Penal Code section 11105.3 and the National Child Protection Act, as amended by the Volunteers for Children Act, this form must be completed and signed by every current or prospective applicant, employee, or volunteer, for whom criminal offender record information (CORI) is requested by a qualified entity under these laws.

I hereby authorize Crossroads Community Church of South Orange County to submit a set of my fingerprints to the California Department of Justice for the purpose of accessing and reviewing state and federal CORI that may pertain to me. By signing this Waiver Agreement, it is my intent to authorize the dissemination of any state and federal CORI that may pertain to me to the qualified entity.

Agree

I understand that, until the CORI background check is completed, the qualified entity may choose to deny me unsupervised access to children, the elderly, or individuals with disabilities. I further understand that if the information is the basis for an adverse decision, the qualified entity will expeditiously provide me a copy of the CORI background check report, and that I am entitled to challenge the accuracy and completeness of any information contained in any such report. I may obtain a prompt determination as to the validity of my challenge before a final decision is made.

Agree

Yes, I have (OR)

No, I have not been convicted of or pled guilty to a crime.

If "Yes" please describe the crime(s) and the particulars.

I am a current or prospective:

Employee

Volunteer

Signature

Date: