I hereby authorize Lutheran Volunteer Corps, by and through its independent contractor, Asurint, to procure a consumer report and/or investigative consumer report on me. These above-mentioned reports may include, but are not limited to, information as to my character, general reputation, personal characteristics and mode of living, discerned through employment and education verifications; personal references; personal interviews; my driving history, including any traffic citations; a social security number verification; present and/or former addresses; criminal and/or civil history/records; or any other public record. I understand that I am entitled to a complete and accurate disclosure of the nature and scope of any investigative consumer report of which I am the subject upon my written request to Asurint, if such is made within a reasonable time after the date hereof. I also understand that I may receive a written summary of my rights under 15 U.S.C. 1681et. seq.
I further authorize any person, business entity or governmental agency who may have information relevant to the above to disclose the same to Lutheran Volunteer Corps, by and through Asurint, including, but not limited to, any and all courts, public agencies, law enforcement agencies, regardless of whether such person, business entity or governmental agency compiled the information itself or received it from other sources. I hereby release Lutheran Volunteer Corps, Asurint and any and all persons, business entities and governmental agencies, whether public or private, from any and all liability, claims and/or demands, by me, my heirs or others making such claim or demand on my behalf, for providing a consumer report and/or investigative consumer report hereby authorized.
Further, I certify that any information I submit for the background check is true and correct and that my application will be terminated based on any false, omitted, altered or fraudulent information.
Please submit this form by June 1, 2017.