Life Church Do Gooders - Team Volunteer, Mar 2019

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DISCLOSURE THAT BACKGROUND CHECKS

MUST BE OBTAINED FOR LONG-TERMVOLUNTEERS

UPPERCUMBERLAND HABITAT FOR HUMANITY (UCHFH) values the safety ofchildren, our employees, volunteers and the families we serve. We want to take prudentmeasures to protect our human and material resources. Habitat for Humanityrequires that sex offender checks and criminal background checks be conductedfor all potential partner families, board members, employees and keyvolunteers*, and in particular, those who may have unsupervised contact with achild, the elderly or persons with disabilities., UCHFH reserves the right torecheck sex offender checks and criminal backgrounds at any time during thehomebuilding process, course of employment and/or service.

* Keyvolunteer generally refers to any individual who works eight (8) or more hourseach month and/or has contact with vulnerable populations such as children, theelderly or persons with disabilities.

Anyperson who does not consent to a reoffender check and criminal background checkwill not be permitted to become partner family, work and/or volunteer with UCHFH.

AUTHORIZATIONTOOBTAIN BACKGROUND CHECK

Ihereby authorize Upper Cumberland Habitat for Humanity to obtain abackground check for purposes, including but not limited to volunteering andany other use not prohibited by law, prior to and during my involvement with UpperCumberland Habitat for Humanity. These reports may contain informationregarding my, sex offender and criminal record history, driving record history,and any other type of information that is permissible by all governinglaws. I understand this information may be obtained from companies,corporations, law enforcement agencies, persons, and other agencies, businessesand individuals. I hereby authorize and direct all persons who may haveinformation relevant to any such report to disclose it to Upper CumberlandHabitat for Humanity or its agents.

ThisDisclosure and Authorization is valid for current and future reports, and Ispecifically understand that Upper Cumberland Habitat for Humanity intendsfor this Disclosure and Authorization to cover both the application for volunteeringand any additional reports obtained while I remain a volunteer

DO NOTSIGN UNTIL YOU HAVE READ THE ENTIRE CONTENTS

I certify that I have read and understand the request for disclosure of consumer reports made to me by UCHFH. I certify that I have read and understand the request for disclosure of consumer reports made to me by UCHFH.

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Please list any addresses you have lived in past five years (if other than current) Please list any addresses you have lived in past five years (if other than current)

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Social Security Number (if you prefer not to copmplete this, please put NA and call Amy Jennings, 528-1711 ext. 2 with this info (Tue-Fri, 9a-3) Social Security Number (if you prefer not to copmplete this, please put NA and call Amy Jennings, 528-1711 ext. 2 with this info (Tue-Fri, 9a-3)

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