Applicant's Statement *
This information contained in this application is correct to the best of my knowledge. I authorize any references, churches, ororganizations listed in the application to give you any information (including opinions) that they may have regarding my acterand fitness for children and youth work. I release all such references from any liability for furnishing such evaluations to providedthey do so in good fatih and without malice.I_________________, aslo heerbly authorize, Shin Kwang Church of New York to requesta background check to release information regarding nay record of chargesor convictions contained in its files, or any criminal filemaintained on whether said file is a local, state, or national file and including but not limited to accusations and convictionsfor crimes committed against minors, the fullest extent permitted by state and federal law. I do release said companyShin Kwang Church of New York from all liability that may result from any such disclousre made in response to this request.Should my application be accepted, I agree to be bound by the policies and standard Shin Kwang Church of New York,refraining from any physical punishment or iproper sexual conduct in the performance of my services on behalf of the church.I further state that have carefully read the foregoing release and know the contents thereof and sign this release as my own free act.
