Tarrant County Volunteer Registration

GENERAL INFORMATION

Name

Home Address

Date of Birth

Email
Note: Your email is used to confirm your identity in our client registration process.

Are you a returning volunteer?

Yes No

What role would you like to volunteer in?

Do you speak any languages other than English?

Yes No

What organization, school, or business are you affiliated with?

EMERGENCY CONTACT

Emergency Contact Name

Emergency Contact Phone

LIABILITY RELEASE

I hereby release, indemnify and hold harmless United Way of Tarrant County, the organizers, the agency at which I volunteer, and sponsors and supervisors of all activities, from any and all liability in connection with any injury (including injury caused by negligence) in conjunction with the United Way of Tarrant County VITA Program. I likewise hold harmless from liability any person transporting me to or from this activity. I also certify that I am in good health and able to participate in the program activities. I certify that I am over 18 years of age and am competent to contract my name insofar as the above is concerned. I have read the foregoing release, authorization and agreement, before affixing my signature below and warrant that I fully understand the contents thereof.

COMMUNICATIONS RELEASE

I hereby grant to the United Way of Tarrant County full and absolute permission and all rights to copyright, publish, display and use for any legal purpose my name, likeness and images of my personal property, together with descriptive text or statements, in media that may include, but are not limited to, newspapers, magazines, newsletters, e-mails, Web sites, social media sites, videotapes, CDs, DVDs and radio and television broadcasts. I have read the foregoing release, authorization and agreement, before affixing my signature below and warrant that I fully understand the contents thereof.

CONSENT TO PERFORM CRIMINAL HISTORY / BACKGROUND CHECK IN COMPLIANCE WITH FCRA (FAIR CREDIT REPORTING ACT)

AS SHOWN ON THE ORIGINAL APPLICATION - TO BE USED FOR CRIMINAL HISTORY CHECKS ONLY AND NOT A PART OF THE PERSONNEL FILE. I AM AN APPLICANT FOR EMPLOYMENT / VOLUNTEERISM WITH COMPANY AND HAVE BEEN ADVISED THAT AS A PART OF THE APPLICATION PROCESS, THE COMPANY CONDUCTS A CRIMINAL HISTORY BACKGROUND CHECK. I DO HEREBY CONSENT TO THE COMPANY USE OF ANY INFORMATION PROVIDED DURING THE APPLICATION PROCESS IN PERFORMING THE CRIMINAL HISTORY CHECK. THE COMPANY HAS INFORMED ME THAT I HAVE THE RIGHT TO REVIEW AND CHALLENGE ANY NEGATIVE INFORMATION THAT WOULD ADVERSELY IMPACT A DECISION TO OFFER EMPLOYMENT / VOLUNTEERISM. IN ADDITION, I HAVE BEEN INFORMED THAT I WILL HAVE A REASONABLE OPPORTUNITY TO CLEAR UP ANY MISTAKEN INFORMATION REPORTED WITHIN A REASONABLE TIME FRAME ESTABLISHED WITHIN THE SOLE DISCRETION OF THE COMPANY. UNDER THE FAIR CREDIT REPORTING ACT, I HAVE BEEN ADVISED THAT UPON REQUEST I WILL BE PROVIDED THE NAME, ADDRESS AND TELEPHONE NUMBER OF THE REPORTING AGENCY AS WELL AS THE NATURE, SUBSTANCE AND SOURCE OF ALL INFORMATION. THE FOLLOWING ARE MY RESPONSES TO QUESTIONS ABOUT MY CRIMINAL HISTORY (IF ANY).

Have you ever been convicted or plead guilty before a court for any federal, state or municipal criminal offense? (Exclude minor traffic misdemeanors)?

Yes No

Have you ever received deferred adjudication or similar disposition for any federal, state or municipal offense?

Yes No

Have you ever received probation or community supervision for any federal, state or municipal offense?

Yes No

Electronic signature

Clear