I understand and certify the following:
I promise to faithfully serve the ambulance corps and promote its interests at all times in a professional manner and to the best of my ability.
For the sole purpose of the determination and evaluation of my motor vehicle operating record and pursuant oto the State and Federal regulations of compliance, I authorize CLG Financial Corp and South Orangetown Ambulance Corps to obtain my Motor Vehicle Record. I understand that this record may contain personal information* in addition to any/all driver violations and/or accidents, which may be on record on through the states of NY, NJ, CT & all 50 U.S. States — State Department of Motor Vehicles.
I also authorize release of this information to my employer.
*Personal information means information that identifies an individual including an individual's photograph, social security number, driver identification number, name, address, and telephone number. It does not include information on vehicle accidents, driving violations, and driver status.
I voluntarily hereby authorize the South Orangetown Ambulance Corps Membership Committee / Corps Officers and Directors, to make inquiries into all of my records, including but not limited to Criminal History, Driving Records, Arson, as well as Employment, Educaiton, and Training history. I further authorize and give permission to the Corps to contact the refrences I designated in my application for membership to the South Orangetown Ambulance Corps. I understand that all information will be kept in strict confidence by the Corps and used for the purpose of my eligability and standing as an acceptable candidate for membership in the Corps and the services the Corps provides to the community.