Background Check

Volunteer Background Check Authorization Form

PLEASE COMPLETE ALL REQUIRED INFORMATION IN ORDER TO HAVE CODE 3 SEARCH AND RESCUE PEFORM A BACKGROUND CHECK

Name

Social Security Number

Date of Birth

Street

City

State

Zip Code

Phone

I hereby authorize Code 3 Search and Rescue to conduct a security background check on me. I understand that this security check will cover information including, but not limited to, criminal history, education and employment. I hereby release Code 3 Search and Rescue and its elected officials, employees, agents and assigns, as well as the Company performing the background check and its employees, from all liability resulting from the furnishing of this information to Code 3 Search and Rescue.

I certify that the statements made by me on this form are true, complete, and correct to the best of my knowledge and belief, and are made in good faith. I understand that any false statements made herein could void my consideration as a Code 3 Search and Rescue employee or volunteer.

If you agree for Code 3 Search and Rescue to perform a background check on you, please sign the "Electronic Signature", fill in the "Date" and click "Submit"

Electronic Signature

Date