Records Check

It is not our policy to know your past to keep you out of Dayspring, ECC, AECUSA or Crossroads. Due to the times in which we live it is in the best interests of all of Dayspring to try to find those who would be decietful in Christ's Ministry. This is not personal but is now required of all who would do ministry in these "Last Days" with Dayspring and its Sister, affiliated partners.

REQUEST FOR BACKGROUND 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 from any and all liability resulting from such disclosure.

Record Check Sent To:

Dayspring Ministry Group

P.O. Box 3634

Brookhaven, MS 39603-7634

Attn: Dr. Gary Barkman

President, the ECC&DMI

CONFIDENTIAL

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Signature

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Print Name

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Print Maiden Name (If Appoicable)

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Print All Aliases

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Date of Birth

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Place of Birth

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Social Security Number

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Today’s Date

The above signed does authorize the release of any of his/hers records to Dayspring Ministries International, P.O. Box 3634, Brookhaven, MS 39603-7634

If Dayspring runs your record check please add an additional $50.00 to your filing fee. If you have it run there is not an additional fee.