Volunteer Background Check

If you are interested in volunteering specifically with any of our programs where you will interact directly with children, please understand that a background check is required by Tennessee state law. In addition to ensuring safe relationships for our children, we are required to collect this information by funding sources.
1. Name *
1. Name
Address *
Phone *
In connection with my volunteer application with St. Luke’s Community House, I understand a background check will be conducted. The information verified might include but may not be limited to character, work habits, performance, and expertise. I agree to provide the Volunteer Program Manager with the names and telephone numbers of two references. I understand that until these references are returned, I may not be allowed to provide direct service volunteer work.
I also understand that if I will be transporting clients or working directly with children, St. Luke’s may request information from federal, state, and other agencies which maintain records concerning traffic offenses, accidents, or criminal history. I authorize, without reservation, any party or agency contacted by a representative of St. Luke’s to furnish the above mentioned information. I understand that if I use my personal automobile for volunteer work with St. Luke’s and should an accident occur, my personal auto car insurance will be held liable.
Date *
St. Luke’s Community House is required by the Tennessee Child Abuse Law (TCA 71-3-529) to inquire if you have ever been convicted of a felony (including a suspended sentence).
Have you ever been involved in violations of the law which are classified as felonies, including any conviction involving a sentence or suspended sentence, and including any sexual offense not expunged by law? *
Falsification of required information may subject the person to criminal prosecution. It shall be unlawful for any person to falsify any information required on the application. Knowingly failing to disclose required information shall be deemed to be falsification to the same extend as providing false information. I attest that the above information is true and correct.
Date *

Can’t fill out this form? Download a copy here. Scan and return to Christie.Bearden@stlch.org 

Continue filling out Volunteer forms: Volunteer Application & Volunteer Waiver