Camp Fire Wilani Background Check Consent Form For Employees and Volunteers
To serve the best interest of Camp Fire Wilani and to protect our youth, volunteers and
employees, Camp Fire Wilani conducts a background check on all new employees and
volunteers. By your signature, you authorize Camp Fire Wilani to obtain this information
about you. Falsification of information on this form will disqualify you from employment
and volunteer status.
Email *
Full Name (Last, First, Middle) *
Other Names Used *
Date of Birth *
Social Security Number *
Driver's License # and State *
Current Address *
Other counties/states lived during the past 2 years (If none, please enter "none.") *
Electronic Signature
The parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purpose of validity, enforceability and admissibility.
I hereby consent to a criminal records check and provide the information set forth. I hereby agree that Camp Fire Wilani may use any information derived from the criminal records check in evaluating my fitness to serve as a Camp Fire volunteer or employee. I have made no willful misrepresentations,omissions or falsifications of any of the preceding answers. I am aware that should investigation disclose such misrepresentations, falsifications, or omissions in the information I have submitted in the application Process, my application will be rejected. If, after acceptance for employment or volunteer status subsequent investigation should disclose misrepresentation, falsification, or omission, it will be just cause for immediate dismissal.
Signature *
Date *
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