Oce of Enrollment Management | Trinity Bible College | 50 6th Avenue South | Ellendale, ND 58436-7105
phone: 800.523.1603 | email: admissions@trinitybiblecollege.edu | website: www.trinitybiblecollege.edu
Trinity Bible College
Background Check Authorization Form
TriniTy Bi Ble Colleg e reserves Th e righ T To Co n duCT BaCkgro und C heCks of sTude nTs for seCu riTy
pu rpose s. al l inf ormaTion will Be k epT s TriCTly Confid e nTia l .
Name (Last, First, MI):_________________________________________________________________________________________
Have you ever used any other name(s)? If so, please list all:___________________________________________________________________
Current Address:_____________________________________________________________________________________________
Street & Number City State Zip
Permanent Address:__________________________________________________________________________________________
Street & Number City State Zip
Date of Birth:______________________________________ Social Security Number:______________________________________
(month/day/year)
Have you ever been arrested or convicted of any criminal oense(s)? Yes No
If yes, please explain the charges, verdict and circumstances:_________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Date of oense(s):______________________________
State of oense(s):___________ County of oense(s):_________________________________
Note: Answering “yes” to any of these questions does not automatically disqualify you as an applicant nor does it automatically disqualify you from participating in Student Ministries.
I hereby authorize Trinity Bible College to make an independent investigation of my background and criminal or police records. I release Trinity
Bible College, and any person or entity which provides information pursuant to this authorization, from any and all liabilities, claims or law
suits in regards to the information obtained from any and all of the above sources. I agree to waive any right to bring legal action against
Trinity Bible College or the background check agency for the disclosure of such information. The information contained in this application is
correct to the best of my knowledge.
Signed:___________________________________________________________ Date:______________________
If applicant is under the age of 18, a parent or legal guardian must sign below for authorization.
Signed (Parent or Legal Guardian):_____________________________________ Date:______________________
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