I consent and authorize Girl Scouts—Dakota Horizons to obtain an independent criminal background report and Social Security number validation report through Asurint. I further authorize Girl Scouts – Dakota Horizons to request or receive information which will include but not be limited to motor vehicle reports, past employment and education records, and/or references from any persons, schools, or previous volunteers only if pertinent to my potential work as a volunteer. I understand that a credit report may be requested if my assignment includes handling money. Information appearing on this Authorization will be used exclusively by Asurint, 1501 Euclid Ave. Cleveland, OH 44115. and Girl Scouts—Dakota Horizons for identification purposes and for the release of information which will be considered in determining suitability for volunteering. I agree to provide additional information if necessary to process my application. I understand that the pre-appointment background check requires my full name, date of birth, driver’s license number and social security number. I understand that the information I have provided may be verified by contacting persons or organizations listed in the application or by contacting any person or organization that may have information concerning me. I certify that entries made by me in this form are true, complete, and accurate to the best of my knowledge, and are made voluntarily and in good faith. I understand that any false statements or answers by me may disqualify me for volunteer services or will be sufficient grounds for termination. Moreover, I understand that failure to complete this form will preclude me from volunteer opportunities with the Girl Scouts – Dakota Horizons. I understand and agree that any omission, false statement, misleading statement, or answer made by me on my application or any supplements to it and in any interviews will be sufficient grounds for rejection or discharge from appointed position. I further understand that I will receive a complete and accurate disclosure of the nature and scope of the background verification, in the event such investigation negatively affects my placement as a volunteer. I hereby release and agree to indemnify Girl Scouts – Dakota Horizons and Asurint and each of their officers, directors, employees, and agents harmless from and against any and all liability, expense (including court costs and attorneys’ fees) and claims for damage of any nature whatsoever. I authorize without reservation, any party or agency contacted by Asurint to furnish the above-mentioned information. This authorization will remain valid during the course of my involvement with Girl Scouts—Dakota Horizons.