Internship Application

Date

Employer info, position, years worked

Freedom Church or other

If yes, please explain.

If yes, please explain.

If no, would you be interest in pursuing it? Why or why not?

If no, would you be interest in pursuing it? Why or why not?

AUTHORIZATION FOR RELEASE ON INFORMATION TO FREEDOM CHURCH OF GRAND FORKS, ND
I, the undersigned, do hereby authorize Freedom Church and its affiliates, agents and employees to conduct background checks and receive all information relative to the undersigned by and through any local, state or federal law enforcement agency, including but not limited to the Federal Bureau of Investigation (FBI) and National Crime Information Center (NCIC) regarding arrests, convictions, and charges pending against me within or outside the state of North Dakota and waive any rights I have relative to sealed court files which release to my records of mental health history, if any are there. I waive any privileges pursuant to Confidential and Privileged Communication Law.

Date

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