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By submitting this application, I, the undersigned applicant, do hereby certify that the information provided by me for the purpose of the employment/volunteer worker assignment is true and complete to the best of my knowledge. I hereby authorize The Boys & Girls Club of West Cook County (sometimes herein as "BGCWCC") to investigate all statements contained in this application to determine my suitability for this volunteer assignment, and otherwise investigate my character, reputation, personal characteristics, work habits, performance, experience, skills and/or abilities. BGCWCC or any of its agents, are also authorized to verify and conduct any investigation into my personal, motor vehicle, and employment history and request any records related thereto, and to request and receive any and all criminal history record information pertaining to me.
I authorize schools, law enforcement and governmental agencies of any kind, current or former employers, whether or not named in this application, and any other references or persons with knowledge of me to provide BGCWCC with any information, verbally and/or in writing, which may be requested, including but not limited to information concerning employment, criminal, driving and any other records or reports, evaluations and reasons for any termination. I further authorize any of BGCWCC agents or representatives to disclose orally or in writing the results of this verification or interview process to other BGCWCC agents or representatives, including agents or representatives of the Boys & Girls Clubs of America.
I hereby hold harmless all persons, organizations, agencies, et al., who provide BGCWCC with any information, and such entities or persons are hereby fully released from any and all claims and damages that may be connected with their release of any of the information they provide. Furthermore, I do hereby agree to forever release, indemnify and hold harmless BGCWCC, their agents and assigns, to the full extent permitted by law, from any claims, damages, losses, liability, costs and expenses or any other charge or complaint related to this authorization and the retrieving and reporting of information.