Boys & Girls Clubs of Albany

 

MENTORING

BACKGROUND INVESTIGATION CONSENT

 

I hereby authorize Boys & Girls Clubs of Albany and/or its agents to make an independent investigation of my background, references, character, past employment, education, credit history, criminal or police 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 volunteering now and, if applicable, during the tenure of my volunteering with Boys & Girls Clubs of Albany, Inc.

 

I release Boys & Girls Clubs Albany, Inc. and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the information obtained from any and all of 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:

 

 

________________________________________________       _____________________________
Full Name (Printed)                                                                                             Phone Number

 

 

 

________________________________________________________________________________
Street Address                                                                    City                                               State                   Zip

 

 

 

_____________        __________________         _________________  ______        ____    __________
*Date of Birth                   Social Security Number                Driver’s License Number     State            *Sex      *Race

 

 

 

_____________________________________________________                ____________________
Signature                                                                                                                                Date

                                       (must be signed in the presence of a notary)

*NOTE:  The above information is required for identification purposes only.

 

 

 

 

 

 

                                                                 _____________________________________     ________________________
                                                                 Notary                                                                     Date

 

                          SEAL