(CA) LIVESCAN ANNUAL WAIVER

First Name

Last Name

Phone Number

This form grants permission for Calvary Chapel Escondido to access and review DOJ (State) and FBI (Federal) Criminal Offender Record Information (CORI) concerning the employee or volunteer annually to maintain workplace safety and compliance pursuant to legal requirements under §11105.3 of the California Penal Code.

CONSENT TO OBTAIN CRIMINAL HISTORY INFORMATION

I hereby authorize Calvary Chapel Escondido and its authorized representatives to conduct Live Scan criminal history checks including requesting, obtaining, and reviewing Criminal Offender Record Information (CORI) on an ongoing basis for the duration of my employment or volunteer service with the organization.

Yes

I understand that this consent allows the employer/organization I am serving and its authorized representatives to obtain information regarding past and present criminal charges, convictions, and/or other legal matters that may be relevant to my employment or volunteer service. I acknowledge that the information will be gathered and used solely for employment- or volunteer-related purposes and to ensure compliance with applicable laws, regulations, and workplace policies.

Yes

Acknowledgement of Applicant’s (Employee or Volunteer) Rights

I understand that I have the right to request and obtain from the California Department of Justice a copy of my background screening report, including any DOJ or FBI criminal history records contained in the Live Scan report. I acknowledge that I have the right to dispute any inaccurate or incomplete information discovered during the review process. I understand that this consent form is valid for the duration of my employment/volunteer service unless revoked by me in writing. I may revoke this consent at any time, but I acknowledge that such revocation may affect my continued employment or volunteer service.

Yes

Confidentiality

I understand that any Criminal Offender Record Information obtained through this process will be kept confidential and will only be shared with authorized personnel who are involved in employment decisions, volunteer service eligibility decisions, legal matters, and/or organizational compliance.

Yes

Waiver of Liability

I release and hold harmless Calvary Chapel Escondido, its affiliates, and any background check providers, from any liability, claims, or damages arising from the release or use of criminal history information obtained under this authorization, provided that the information is used in accordance with applicable laws and regulations.

Yes

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(CA) LIVESCAN ANNUAL WAIVER

CONSENT TO OBTAIN CRIMINAL HISTORY INFORMATION

Acknowledgement of Applicant’s (Employee or Volunteer) Rights

Confidentiality

Waiver of Liability

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