Any applicant who knowingly or willfully makes a false statement of any material or thing in the application is guilty of perjury in the second degree as defined in Section 18-8-503, C.R.S., and, upon conviction thereof, shall be punished accordingly. I am willing to be subject to the jurisdiction of Cross Bar X Youth Ranch for the current camping session. I understand that this applies to each camp and for the days between camps. I agree to abide by all camp policies and procedures. I also understand that the position for which I am applying will be very demanding physically, emotionally, and spiritually and I am willing to explore to the maximum every opportunity available for ministry and personal growth. I choose to cooperate with the staff and will openly share any disagreements or problems in a spirit of love if those circumstances should arise. I have considered this matter prayerfully.
NOTICE REGARDING BACKGROUND INVESTIGATION
Cross Bar X Youth Ranch may obtain information about you from a consumer reporting agency for employment/volunteer purposes. Thus, you may be the subject of a “consumer report” and/or an “investigative consumer report” which may include, but is not limited to: employment and education verifications; social security number verification; criminal and civil court records; personal interviews; driving records; and/or any other public records or any other information bearing on your character, general reputation, personal characteristics and trustworthiness. These reports may be obtained at any time after receipt of your authorization and, if you are selected, throughout your affiliation with Cross Bar X Youth Ranch. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report. The report will be generated by Datasourcecorp.com (1200 South Outer Road, Blue Springs, MO 64015/816-228-5255) or another outside organization. The scope of this notice and authorization is all-encompassing, however, allowing Cross Bar X Youth Ranch to obtain from any outside organization all manner of consumer reports and investigative consumer reports now and, if you are selected, throughout your affiliation with Cross Bar X Youth Ranch to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report.
ACKNOWLEDGMENT AND AUTHORIZATION
I acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION (above) and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT (available here) and certify that I have read and understand both of those documents. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” at any time after receipt of this authorization and, if I am selected, throughout my affiliation with Cross Bar X Youth Ranch. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by Datasourcecorp.com, another outside organization acting on behalf of Cross Bar X Youth Ranch, and/or Cross Bar X Youth Ranch itself. I agree that a facsimile (“fax”) or photographic copy of this Authorization shall be as valid as the original.