Since I will be working with children, I hereby authorize West Side Christian Academy, and/or its agents to make an
independent investigation of my background, references, character, past employment, education, criminal or
police records, including those maintained by both public and private organizations, and all public records for the
purpose of confirming the information contained on my application and/or obtaining other information which may
be material to my qualifications for working with children.
I release West Side Christian Academy and/or its agents and any person or entity, which provides information
pursuant to this authorization, from any and all liabilities, claims or lawsuits in regards to the information obtained
from any and all of the above referenced sources used.
The following is my true and complete legal name and all information contained herein is true and correct to the
best of my knowledge: