Notice to Volunteers Regarding Background Investigation
By electronic submitting this form I authorize the Rossville Consolidated School District to
seek the release of investigatory information, including a criminal history, possessed by any
private or public employer or any local, state, or federal agency. I authorize these private or
public employers, or local, state, or federal agencies to provide the Rossville Consolidated
School District any information they may release concerning the matter described herein, and I
will cooperate to the extent necessary to obtain the release of this information.
I expressly waive in connection with any request for, or provision of such information, any
claims or causes of action, including without limitation, defamation, infliction of emotional
distress, invasion of privacy or interference with contractual relation that I might otherwise have
against the Rossville Consolidated School District, its officials, employees, trustees, or agents,
or against any individual, corporate, and/or agency provider of such information. I have read
this authorization and release of all claims, and I expressly agree to the terms set out herein.
I certify that all information I have provided in connection with this background check is
true, accurate and complete to the best of my knowledge.
I understand that I am volunteering my services and declare in no way shall I be
considered an employee or subcontractor or independent contractor of Rossville Consolidated
I understand that I have specific prescribed rights as a consumer under the Fair Credit
Reporting Act and may have additional rights under relevant state laws.
Date of Birth (For ID purposes only)
List any other names you have been known by:
Nationality (Please check only one- For ID purposes only)
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