Volunteer Authorization for Release of Background Information
In connection with my application to volunteer at Church of the Hills, (COTH) I, ______________________________ (applicant’s complete name) authorize COTH and/or its agents to make an independent investigation of my background, references, character, past employment, education, criminal, or policy records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my application and/or obtaining other information, which may be material to my qualifications for employment with COTH.
I release COTH and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims, or lawsuits in regards to information obtained from and all the above referenced sources used.
The following is my true and complete legal name, and all information is true and correct to the best of my knowledge.
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Full name (printed) |
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Maiden name or other names used in the past |
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Present Street Address |
How long? |
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City/State |
Zip |
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Former Street Address |
How long? |
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City/State |
Zip |
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Date of birth |
Social Security # |
Driver's License # |
State |
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Signature |
Date |
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