Attestations for COLED Membership

COLED

Consent Form for Verification of Degree and Work Experience
I *
hereby authorize the Coalition of Liberian Experts in the Diaspora (COLED) to verify my degree and work experience for the purpose of membership application and renewal.
Type a question

Hereby authorize the Council of Liberian Experts in the Diaspora, Inc. (COLED) to verify my qualifications for membershipUnderstand that the information provided on my application will be used to determine membership eligibility and that any false or misleading information may result in the rejection of my application or the revocation of my membership.Hereby release and hold harmless COLED, its officers, agents, and members from all claims, damages, or liabilities arising from the verification of my qualifications for membership.Understand that the verification process may require the disclosure of my personal information to a third-party verification service, and I agree to such disclosure.
By signing below, I acknowledge that I have read and understand the terms of this consent form and authorize COLED to verify my qualifications for membership.
By signing below, I acknowledge that I have read and understand the terms of this consent form and authorize COLED to verify my qualifications for membership.*

YESNO
Name of Applicant*

First NameMiddle NameLast Name
Date

MonthDayYear
Date
Questionnaire and Attestations for COLED Membership

Please answer the following questions. If you answer “Yes”, please provide an explanation in the area below or attach a separate sheet with details.
FAILURE TO ANSWER HONESTLY AND COMPLETELY ANY OF THE QUESTIONS BELOW MAY RESULT IN A REJECTION OF YOUR MEMBERSHIP APPLICATION.
1. Have you EVER been convicted of, had a judgment withheld or deferred, or are you currently charged with committing any felony? *

YESNOIf YES PLEASE EXPLAIN BELOW
Explanation
2. Are you currently a party to or have you ever been found liable in any lawsuit, claim, investigation or proceeding alleging corruption, breach of trust or fiduciary duty, forgery, fraud, or any other act of dishonesty?*

YESNOIf YES PLEASE EXPLAIN BELOW
Explanation
3. Has any court, governmental agency, institution, or international organization ever refused, denied, suspended, or revoked your professional license or disciplined you by sanctioning and/or restricting your activities?*

YESNOIf YES PLEASE EXPLAIN BELOW
Explanation
4. Have you ever been the subject of any professional license/registration or market conduct investigation, claim or proceeding?*

YESNOIf YES PLEASE EXPLAIN BELOW
Explanation
5. Are there any outstanding judgments, liens, salary garnishments or claims against you?*

YESNOIf YES PLEASE EXPLAIN BELOW
Explanation
I hereby confirm that I have read the COLED Constitution/Bylaws and promise to abide by its terms and provisions including future amendments that may be adopted by the member*

YESNO
I certify that the information contained herein is true and complete to the best of my knowledge and belief. I understand that failure to provide true and complete information in this application may result in the rejection of this request for membership and/or subsequent termination thereof.
Name

First NameMiddle NameLast Name
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COLED

Questionnaire and Attestations for COLED Membership