Girl Scouts of Western Ohio

OF WESTERN OHIO

I give my permission for Girl Scouts of Western Ohio to obtain information relating to my criminal history record which may be obtained through a consumer report. I authorize a complete criminal history record check as received from the reporting agencies and authorized investigators, which may include arrest and conviction data as well as plea bargains and deferred adjudications. I understand that this information will be used, in part, to determine my eligibility for a volunteer/employment position with this organization. I also understand that as long as I remain a volunteer or an employee here, the criminal history records check may be repeated at any time. I understand that if Girl Scouts of Western Ohio chooses not to extend an offer of an appointment/employment to me based upon the information, that I will be provided a copy of such information along with a summary of my rights under the Fair Credit Reporting Act.
I, the undersigned, do for myself, my heirs, executors and administrators and assigns hereby remise, release, and forever discharge the Girl Scouts of Western Ohio and each of its officers, directors, employees, and agents from and against any and all causes of actions, charges, liabilities, claims, and demands whatsoever, encompassing all claims for damages, including court costs, expenses and attorney's fees, resulting from the investigation of my background in connection with my application to become a volunteer/paid staff member. I agree to hold Girl Scouts of Western Ohio harmless and to indemnify it from any such causes of action, charges, liabilities, claims and demands which might in the future be made from or by any party claiming by, under or through me.

I understand that the use of my Social Security Number on the criminal history records check shall be used for NO other purpose other than to make the process for conducting a background search more accurate. Furthermore, I understand that it shall not be sold, or in any way transferred to a third party except for the express purpose of conducting the check.

Only persons applying for a volunteer or paid staff position at Girl Scouts of Western Ohio are authorized to complete this form.

Password:
I acknowledge that my electronic signature indicates that I have read, understand, and consent to the above statements.
YOU MUST AGREE TO THE TERMS AND CONDITIONS

Girl Scouting builds girls of courage, confidence, and character, who make the world a better place.

Administrative Office

4930 Cornell Road, Cincinnati, OH 45242-1804

T: 513-489-1025 or 800-537-6241, F: 513-489-1417