* Conviction of a motor vehicle violation or crime will not automatically result in your disqualification. The seriousness of the offense and the date of conviction will be considered in relation to the particular position(s) available or for which you have applied.

I certify that all of the above information on this application and on all other volunteer-related documents that I have submitted is true and complete. I understand that any misrepresentation or omission may result in my disqualification from further consideration for volunteering or my termination from volunteering.

Further, in order that Riverbend Community Mental Health Services, Inc. may process my application for volunteering, I hereby authorize Riverbend Community Mental Health Services, Inc., its subsidiaries, officers, directors, employees, representatives, and agents (hereinafter collectively referred to as “Riverbend”) to conduct a complete investigation into my background including, but not limited to, inquiring into my employment history, including my fitness for duty at all prior volunteer opportunities; education history; credit history; criminal record and military record, if any; to obtain opinions and references regarding my moral character and reputation and to solicit and obtain any other information Riverbend in its sole discretion deems as necessary to determine my eligibility for volunteering or for the purposes of confirming the accuracy and completeness of any information I provided to Riverbend. In consideration for the processing of my application for volunteering with Riverbend, I hereby release, indemnify and hold harmless Riverbend from any and all liability based on their authorized receipt, disclosure, and use of the information gathered in the processing of my application for volunteering. I further release from liability any person or organization that provides information concerning me.

By my signature, I acknowledge that I have read and understand the foregoing and so authorize and release Rirverbend.