Volunteer Authorization For Release of Background Information

 

In connection with my application for volunteer service with Mid Del Public Schools, I authorize Mid Del Public Schools  and, or, ACCUFAX Div., Southvest Inc., their agent, to solicit background information relative to my criminal record history. I understand that Mid Del Public Schools may conduct inquiries into my background that may include criminal records, motor vehicle records, personal references and other public record reports pertaining to me.  When requested by an employer motor vehicle records or a driving history may be obtained.  American Driving Records will provide motor vehicle records from the state of Louisiana.

 

I authorize without any reservation, any person, agency, or other entity contacted by Mid Del Public Schools or ACCUFAX Div., Southvest Inc., their agent for purposes of obtaining background report information, to furnish the above-mentioned information.

 

I release Mid Del Public Schools, their respective employees or ACCUFAX Div., Southvest Inc. their agent and employees and all persons, agencies and entities providing information or reports about me from any and all liability arising out of furnishing any such information or reports.


Step :
 
 
 
Personal Information
 
 
 
 
 
Full Legal Name
 
First Name
M.
Last Name

First Name / Last Name
 
 
 
Address
 
Address 1
Address 2
City
State
Zip Code
 
 
 
Phone
 
 -  - 
(XXX)-XXX-XXXX
 
 
 
Email Address
 
 
 
 
Date of Birth:
 
Click to View Date Picker
 
 
 
Social Security Number
 
 
 
 
Drivers License #
 
 
 
 
Are you a citizen of the United States?
 
 
 
 
Have you ever been convicted of a felony?
 
 
 
 
If yes, please explain
 
 
 
 
Please List Your Previous Address Information Below:
 
 
Address
 
Address 1
Address 2
City
State
Zip Code
 
 
 
Please List Your Previous Address Information Below:
 
 
Address
 
Address 1
Address 2
City
State
Zip Code
List all city/states resided at since age 18 and how long in each city/state.
 
 
City/State Information