Every applicant for certification as a member of AACT and Domestic Violence Specialist is subject to a records
check to verify that applicant has a record clear of all outstanding criminal complaints, has no conviction for a ‘crime
against person’, no conviction for child abuse or elder abuse, no felony conviction within the past five years or misdemeanor
conviction within the past two years, and is not on probation or parole.
You may send a valid records check that has been made by a recognized public authority or private agency within
the past twelve months, or fill out this form and we will check your records for you.
AACT has not had a single occurrence with a member. Our goal in setting
up this records check system is to uphold the integrity of the organization and its members’ reputations, and keep AACT
free from any who may choose to abuse their clients.
REQUEST FOR CRIMINAL RECORDS CHECK AND AUTHORIZATION
I hereby request Choice Point/Volunteer Select to release any information which pertains to any record of convictions
contained in its files or in any criminal files maintained on me whether local, state, or national. I hereby release Choice Point/Volunteer Select, AACT and Jubilee Enterprises, d.b.a. AFS Family Skills
Institute from any and all liability resulting from such disclosure.
___________________________ Request for Record Check Sent To:
P.O. Box 143
Tolar, TX 76476
___________________________ Attn: Dr. Gary W. Barkman
Enclose your check or money order
In the amount of $50.00
Print Maiden Name (If Applicable)
Print All Aliases ever used
Date of Birth
Place of Birth
Social Security Number
applicant, by signing above, authorizes the release of any and all of his/hers criminal records to Dayspring Ministries International,
P.O. Box 143, Tolar, Texas 76476.