Background Information Disclosure Form Agreement

I, the undersigned, hereby understand and acknowledge that Congregational Home will conduct arrest/conviction record checks through the State of Wisconsin’s Department of Justice, in accordance with the provisions of sections 48.685 and 50.065 of the Wisconsin Statutes. I acknowledge that these record checks will be conducted periodically throughout my employment with Congregational Home, in accordance with the previously mentioned Wisconsin Statutes.

I understand that completion of this form is required for processing my application for employment and that falsifying or omitting information may be grounds for withdrawal of this job consideration, or subsequent termination of employment.

I understand that this completed form will be used to conduct arrest/conviction records checks throughout my employment with Congregational Home per the aforementioned Wisconsin Statutes.
I understand that the Department of Justice will release to Congregational Home, full and complete information in their records regarding any arrest and/or conviction, whether a felony or misdemeanor, under my name, date of birth, and social security number.

I also acknowledge that having a criminal history may not disqualify me from employment, a job transfer, or promotion with Congregational Home. Several factors will be taken into consideration, including the nature and gravity of the crime, its relationship to the position, and the time since the conviction.