I hereby authorize Special Reach Inc. and/or its agents to make an independent investigation of my background, references, character, 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 employment or volunteer service now and, if applicable, during the tenure of my employment/volunteer service with Special Reach Inc. The criminal history record, as received from the reporting agencies, may include arrest and conviction data as well as plea bargains and deferred adjudication and delinquent conduct committed as a juvenile. I understand that this information will be used, in part, to determine my eligibility for an employment/volunteer position with this organization. I also understand that as long as I remain an employee/volunteer here, the criminal history records check may be repeated at any time. I understand that I will have an opportunity to review the criminal history as received by Special Reach Inc., and that a procedure is available for clarification, if I dispute the record as received.
I, the undersigned, do for myself, my heirs, executors and administrators, hereby release and forever discharge and agree to indemnify Special Reach Inc., and each of their officers, directors, employees, and agents and hold them harmless from and against any and all causes of actions, suits, liabilities, costs, debts, and sums of money, claims, and demands whatsoever (including claims for the negligence, gross negligence, and/or strict liability of Special Reach Inc.), and any and all related attorney’s fees, court costs, and other expenses resulting from the investigation of my background in connection with my application to become a volunteer/staff member.
The following is my true and complete legal name and all information is true and correct to the best of my knowledge: