VITA Volunteer Background Check Form

If you are a new volunteer, please complete the entire background check form and make sure to submit.  This is not required for returning VITA volunteers.  Please note if you are a new volunteer we cannot consider your application without the VITA Volunteer Application.

The information required within this Background Check Form is secure and is required by law enforcement agencies and other entities for positive identification purposes when checking public records.  It is confidential and will not be used for any other purposes.  By completing this Background Check form, you are releasing United Way of Kenosha County and agents and all persons, agencies, and entities providing information or reports about you from any and all liability arising out of the mentioned information or reports.  

If you have any questions, please contact us at unitedway@kenoshaunitedway.org or call 262-658-4104.  

Thank you.

In connection with my volunteer service with the Volunteer Income Tax Assistance (VITA) Program, I understand that a consumer report or an investigative consumer report may be requested.  I understand that you may be requesting information from public and private sources about my criminal record and social security validation.  

I acknowledge that a telephonic facsimile (fax), electronic copy, or photographic copy shall be as valid as the original.  The release is valid for most federal, state, and county agencies.