I, First & Last Name*, hereby authorize the Blair County Historical Society to perform a background check and investigate any public records relating to my criminal history or lack thereof. The organization will only use these findings to make an initial decision and will not further disseminate records. Additionally, I certify, to the best of my ability, that all of the information in this application is accurate. I understand any false statements may disqualify me from working with this non-profit organization.
Administrative Use Only -Approved By BCHS Representative: _____________________________Date Approved: _____________________________