I hereby give my permission to the Texoma Senior Corps Program to obtain information relating to my criminal history record through the National Service Criminal History Check process which includes information obtained through up to three components:
The criminal history record, as received from the reporting agencies, 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 an employment/vollunteer position with this Senior Corps authorized grantee organization. I understand that if I have been convicted of murder or required to register as a sex offender, I am ineligible to work or serve in this position. I also understand that as long as I remain an employee or volunteer here, the criminal history records check may be repeated at any time. I understand that I will have an opportunity to review the criminal history and a procedure is available for clarification if I dispute the record as received.
I do, for myself, heirs, executors and administrators, hereby remise, release and forever discharge and agree to indemnify the Texoma Council of Governments and its entities, directors, employees and agents, harmless for any and against any and all causes of actions, suits, liabilities, costs, debts and sums of money, claims and demands whatsoever and any and all related attorneys' fees, court costs and other expenses resulting from the investigation of my background in connection with my application to become a volunteer/staff member.
I understand that volunteering for the Foster Grandparent Program is a firm commitment to serving the minimum hours required. Program acceptance is contingent upon meeting all CNCS requirements. I certify that I am at least 55 years of age and, if applicable, I maintain automobile liability insurance equal to or greater than the minimum required by state law.
I certify that to the best of knowledge all information on this application is true and correct.