By typing my name below it is understood and agreed upon that any misrepresentation by me on this application will be sufficient cause for cancellation of this application and/or separation from service as a volunteer.
I give the organization the right to investigate all references and to secure additional information about me, if related to the volunteer position. I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.
I authorize Southwest Health to obtain a criminal background report and/or investigative criminal background reports for the pre-volunteer background investigation, and, if I am accepted, at any time during my volunteering. I understand that these reports might include, but are not limited to, a search of my criminal background, driving record checks, and verification of my identification and Social Security Number. I agree that this Disclosure/Authorization, in original or copy form, is valid for all current and future criminal background reports.
I understand that Southwest Health may use my criminal background reports for volunteering purposes, including, but not limited to, promotion, retention, and dismissal.