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Volunteer Registration And Consent For Release Of Information

(Applicants 18 years and older please complete all information.

First Name

Middle Name

Last Name

Driver's License Number

State Issued

Birth Date

Current Address

City

State

Postal/ Zip Code

Years at Address:

Consent for Release of Information

By submitting this application, I the undersigned applicant, do hereby certify that the information provided by me for the purpose of the employment/ volunteer worker assignment is true and complete to the best of my knowledge. I hereby authorize Girl Empowerment Inc. to investigate to determine my sustainabilty for this volunteer assignment, and otherwise investigate my character, reputation, personal characterictics, work habits, performance, experience skills and/ or abilties. GE INC. or any of its agents , are authorize to verify and conduct any background checks into my personal motor vehicle, and employment history and request any records related thereto, and to request and recieve any and all criminal history record information pertaining to me. I authorize schools, law enforcement and govermental agencies of any kin, current or former employers, weather or not named in this application, andd any other references or persons with knowledge of me to provide GE INC. with any information, verbally and/or in writing, which may be requested, including but not limited to information concerning employment, criminal, driving, and any other records or reports, evealuations and reasons for any termination. I further authorize any GE INC. staff, agents or representatives to disclose orally or in writing the results of this verification or interview process to GE INC., agents or representatives, including agents or representatives of Columbus, Ohio, Cuyahoga Falls, Ohio Fairfield County, New York. I hereby hold harmless all persons, organizations, agencies., who provide GE INC., with any information, and such entites or persons are hereby fully released from any all claims and damages that may be connected View terms of use

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Date of Submission

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02:30 PM

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Volunteer Registration And Consent For Release Of Information

(Applicants 18 years and older please complete all information.

Consent for Release of Information

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