Volunteer background check authorization

Volunteer background check authorization
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Date of Birth*
Have you ever been charged with or convicted of a crime? *
If yes, please explain
I, name* , authorize Rockin' Horse Farm/Horse Connections to receive information from any law enforcement agency, including police departments and sheriff's departments, of this state or any other state or federal government, to the extent permitted by state and federal law, pertaining to any convictions I may have had for violations of state or federal criminal laws, including but not limited to convictions for crimes committed upon children.

I understand that such access is for the purpose of considering my application as an employee/volunteer, and that I expressly DO NOT authorize Rockin' Horse Farm or Horse Connections to disseminate this information in any way to any other individual, group, agency, organization, or corporation.
Signature of participant or legal guardian*

Clear
Date*

MonthDayYear
Date
Is your driver's license current? * Driver's License number if over 18license number* State state license is from*
I understand that all information (written and verbal) about participants at Rockin' Horse Farm/Horse Connections is confidential and will not be shared with anyone without the express written consent of the participant and their parent/guardian in the case of a minor. Signature of participant or legal guardian* Date*
Should be Empty: