Please note: answering "yes" to any of these questions does not automatically disqualify you. Please use the spaces provided to explain the circumstances.
I hereby authorize... to make an independent investigation of my background and criminal or police records. I release..., and any person or entity which provides information pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the information obtained from any and all of the above sources. The information contained in this application is correct to the best of my knowledge. I understand that any omission of material fact on the application may be grounds for rejection of this application.