CRIMINAL RECORDS CHECK

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:

Applicant Signature

                                                   Dayspring Ministries International

                                                                              P.O. Box 143

                                                                   Tolar, TX  76476

___________________________                Attn: Dr. Gary W. Barkman

Print Name                                                           

                                                                Marked: CONFIDENTIAL

                                                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                             Today’s Date

The 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.