Skip to main content
  • facebook
  • youtube
  • instagram
  • phone
  • email
Hit enter to search or ESC to close
Close Search
Hearts with a Mission
Menu
  • Home
  • About
    • History
    • Board of Directors
    • Our Team
    • Careers
    • Financials
    • Publications
  • Services
    • Youth Shelter
    • Transitional Living Program
    • Safe Families for Children
    • Hearts For Seniors
    • Independent Living Program
  • Events
    • Superhero Run
    • Auction Page
  • Volunteer
  • News
  • Community Supporters
  • Contact
  • We’re Hiring
  • DONATE

Background Application

Step 1 of 2

50%
  • MM slash DD slash YYYY
  • Maiden or Alias
  • (Optional)
  • Max. file size: 100 MB.
  • MM slash DD slash YYYY
  • Residence 1

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • NOTICE – BACKGROUND INVESTIGATION

    Signature of SI Authorizing Background Check Process and Release of Information
  • My submission of this form with my signature authorizes the Background Check Unit (BCU) to initiate a criminal records check, which may include a national criminal records check requiring fingerprints, and to receive the results from Oregon State Police and the FBI. I understand that BCU will complete an abuse check on me. Any information from these checks may be shared with a qualified entity designee at the facility or licensing authority associated with this application.

    My submission of this form with my signature authorizes BCU to request and receive any juvenile, police, court or investigation reports needed to complete this background check. In the event BCU discovers potentially disqualifying convictions or conditions, including abuse, BCU may notify me at the address or email I have given to request additional information.

    My submission of this form with my signature authorizes BCU to release information given in this background check request or position information to any criminal justice agency or investigative body as needed for investigation, outstanding warrants or supervision requirements.

    I authorize BCU to process this background check request. I certify that all statements I have made are currently accurate. I understand that I need to disclose any new information that occurs after I submit this form while the background check is still pending. I understand that if I provide false or incomplete information, my application may be closed or I may be denied the position. I understand the background check may be repeated any time while I hold the position for which this check is being done.

  • MM slash DD slash YYYY

Contact HWAM

Mailing Address:
Hearts With A Mission
711 Medford Center #334
Medford, OR 97504

Office:
529 Edwards St.
Medford, OR 97501
Phone: 541-646-7385
Fax: 541-732-4833

 

 

Locations

Youth Shelter:
517 Edwards Street
Medford, OR 97501
541-646-7385

Transitional Living Programs & Independent Living:
Jackson County

521 Edwards Street
Medford, OR 97501

Josephine County
1504 NE 9th Street
Grants Pass, OR 97526
541-956-4190

 

Subscribe to Our Newsletter

© 2025 Hearts with a Mission. | Privacy Policy
Website design by CMD

  • twitter
  • facebook
  • youtube
  • email
Close Menu
  • Home
  • About
    • History
    • Board of Directors
    • Our Team
    • Careers
    • Financials
    • Publications
  • Services
    • Youth Shelter
    • Transitional Living Program
    • Safe Families for Children
    • Hearts For Seniors
    • Independent Living Program
  • Events
    • Superhero Run
    • Auction Page
  • Volunteer
  • News
  • Community Supporters
  • Contact
  • We’re Hiring
  • DONATE
  • facebook
  • youtube
  • instagram
  • phone
  • email
Font Resize
Contrast
Accessibility by WAH