VOLUNTEER APPLICATION FORM


VOLUNTEER INFORMATION


CHURCH INFORMATION


CRIMINAL HISTORY




APPLICANT STATEMENT

I certify that this volunteer application was completed by me and that all of the information on this application is true and correct to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts called for herein will result in my disqualification from further consideration as a volunteer.

I understand that ALL student/staff information to which I have access as a Capital Christian Center/School volunteer is confidential. Such information might include, but is not limited to, academic, financial, employee and/or health information in written, oral, or electronic form. I agree not to discuss any confidential information, including, but not limited to, any descriptions of situations as well as names of students/staff. I also understand that even when I am no longer a volunteer for CCC/CCS confidential information I have learned as a volunteer must continue to be kept confidential. I understand that any breach of the confidentiality of student/staff information will result in my immediate termination as a volunteer at CCC/CCS and that I may be subject to civil liability in some cases.

My signature indicates that I promise to only share confidential student/staff information with authorized school authorities when required. My signature on this form indicates that I understand and agree to comply with the conditions stated in the CCC/CCS Volunteer Confidentiality policy provided to me on this form. I understand that this volunteer application is not valid without my signature.

The information contained in this application is correct to the best of my knowledge. I hereby authorize Capital Christian Center and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment and/or volunteer purposes. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to the following areas: verification of social security number; current and previous residences; employment history, employment credit history, education background, character references; drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records.

I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to Capital Christian Center or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources.

I hereby release Capital Christian Center, the Social Security Administration, and its agents, officials, representative, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may, at any time, result to me, my heirs, family, or associates because of compliance with this authorization and request to release.

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