23rd Annual Heart of the House Gala presented by the Chad and Patti Hagwood FoundationAugust 1 @ 6:30 pm – 10:00 pm
Background Check Form-Volunteers Background form for guest families only. Which volunteer program are you applying for?*Please select the volunteer program you are applying for so your background check form is directed to the appropriate staff member. Please select only one. Individual House Volunteer Family Activity Group Volunteer Family Meal Group Volunteer Service Group Volunteer Intern Group NamePlease list your organization or company if you are volunteering with a group. Not for employment* In checking this box, I understand that this background check is not being run for employment but for consideration to volunteer at Ronald McDonald House Charities of Alabama. Fair Credit Report Act Discolosure*In conjunction with my application for volunteer service with Ronald McDonald House Charities of Alabama, I understand that you intend to hire SELECTiON.COM® to obtain Consumer Reports and / or Investigative Consumer Reports (Reports) about me as defined in the federal Fair Credit Reporting Act (FCRA). These Reports may include information concerning my academic background, character, credentials, credit capacity, credit standing, credit worthiness, general reputation, mode of living, personal characteristics, reasons for work termination, work experience, work habits and / or work performance. You may also seek information concerning my civil litigation history, criminal record, educational background, employment history, motor vehicle record, and / or worker’s compensation history. I understand that you may rely on the information contained in these Reports in determining whether to extend an offer of volunteer service to me. If you contemplate making an adverse decision that will affect me based, in whole or in part, upon a Report obtained from SELECTiON.COM®, I will receive a copy of the Report and a written summary of my Consumer Rights under the FCRA before you finalize that decision. I have read the above disclosure and I hereby authorize you, SELECTiON.COM® or its authorized agents to obtain the above referenced information about me. I also authorize all agencies, bureaus, employers, information service organizations and individuals to provide any of the above referenced knowledge or information they have concerning me. This authorization shall remain on file and be valid for the duration of my volunteer service with you. It shall serve as an ongoing authorization for you to obtain Reports about me from SELECTiON.COM®. After 12 months have passed, new authorization may be obtained. A photocopy or facsimile of this authorization shall be as valid as the original. Please Print Your Name Notice to Applicants living in CA, OK or MN: By checking this box, I request to receive a free copy of any Consumer Report ordered about me. Notice to California Residents: Under California Civil Code Section 1786.22, you may view the file maintained on you by SELECTiON.COM® during normal business hours. You may also obtain a copy of this file, either in person or by mail, by submitting proper identification and paying the costs of duplication services. You may also receive a summary of the file by telephone by being able to provide adequate identification as to allow SELECTiON.COM® to determine with reasonable certainty that you are the subject of the Report. SELECTiON.COM® is required to have personnel available to explain your file to you and must explain to you any coded information appearing in your file. If you appear in person, another person of your choice may accompany you, provided that this additional person also furnishes proper identification. SELECTiON.COM®’s Privacy Policy can be viewed at www.Selection.com. Enter your email. ** By entering my email address, I authorize SELECTiON.COM to deliver my Report via e-mail.INQUIRY RELEASE*In conjunction with my application for volunteer services with you, I understand that you intend to hire SELECTiON.COM® to obtain Consumer Reports and / or Investigative Consumer Reports (Reports) about me as defined in the federal Fair Credit Reporting Act (FCRA). These Reports may include information concerning my academic background, character, credentials, credit capacity, credit standing, credit worthiness, general reputation, mode of living, personal characteristics, reasons for work termination, work experience, work habits and / or work performance. You may also seek information concerning my civil litigation history, criminal record, educational background, employment history, motor vehicle record, and / or worker’s compensation history. I understand that you may rely on the information contained in these Reports in determining whether to extend an offer of volunteer services to me. If you contemplate making an adverse decision that will affect me based, in whole or in part, upon a Report obtained from SELECTiON.COM®, I will receive a copy of the Report and a written summary of my Consumer Rights under the FCRA before you finalize that decision. I have read the above disclosure and I hereby authorize you, SELECTiON.COM® or its authorized agents to obtain the above referenced information about me. I also authorize all agencies, bureaus, employers, information service organizations and individuals to provide any of the above referenced knowledge or information they have concerning me. This authorization shall remain on file and be valid for the duration of my volunteer service with you. It shall serve as an ongoing authorization for you to obtain Reports about me from SELECTiON.COM®. A photocopy or facsimile of this authorization shall be as valid as the original. I agree that any and all disputes arising from any Report shall be brought only in state or federal court in Hamilton County, Ohio and shall be governed by, and construed in accordance with, the laws of the State of Ohio. Please enter your name. Legal Last Name*Legal First Name*Middle Name*Previous or Maiden Name(if applicable)FOR IDENTIFICATION PURPOSES ONLY: Please enter your date of birth (mm/dd/yyyy)* MM slash DD slash YYYY My prospective employer understands that age is a protected characteristic and that any age related information requested will not be used as the basis for any employment decision.Street Address*City*State*Zip Code*E-Mail Address*List state and counties of residence, other than above, for the last seven (7) years:Notice to California Residents: Under section 1786.22 of the California Civil Code, you may view the file maintained on you by SELECTiON.COM® during normal business hours. You may also obtain a copy of this file, either in person or by mail, by submitting proper identification and paying the costs of duplication services. You may also receive a summary of the file by telephone by being able to provide adequate identification as to allow SELECTiON.COM® to determine with reasonable certainty that you are the subject of the report. SELECTiON.COM® is required to have personnel available to explain your file to you and must explain to you any coded information appearing in your file. If you appear in person, another person of your choice may accompany you, provided that this additional person furnishes proper identification. The SELECTiON.COM® Privacy Policy can be viewed at www.Selection.com. Notice to California Residents: Under section 1786.22 of the California Civil Code, you may view the file maintained on you by SELECTiON.COM® during normal business hours. You may also obtain a copy of this file, either in person or by mail, by submitting proper identification and paying the costs of duplication services. You may also receive a summary of the file by telephone by being able to provide adequate identification as to allow SELECTiON.COM® to determine with reasonable certainty that you are the subject of the report. SELECTiON.COM® is required to have personnel available to explain your file to you and must explain to you any coded information appearing in your file. If you appear in person, another person of your choice may accompany you, provided that this additional person furnishes proper identification. The SELECTiON.COM® Privacy Policy can be viewed at www.Selection.com.