Background Check – Authorization, Waiver and Full Release

Authorization to conduct a full background check and obtain any and all records and other information for volunteer application purposes/serving as a volunteer and full release from liability of all parties for any and all claims, of any nature whatsoever, for volunteer application purposes and performing volunteer services for Bloodworks Northwest (“Bloodworks”) whether on or off Bloodworks work areas or premises.

To the applicant: This form must be filled-out completely, truthfully and with absolute no omissions. Leave no blanks. Direct any questions to a Volunteer Services Supervisor.

READ All INFORMATION CAREFULLY BEFORE SIGNING

I hereby authorize Bloodworks to fully investigate my background and to contact any third party and/or utilize the services of an outside agency or other third party to conduct a complete background investigation on me that will include information, documents and statements of both public and private records, as well as civil and criminal court records as well as records from local, state and federal administrative agencies. I certify under penalty of perjury that the statements and information I have provided in my application and at any time during the process of becoming a volunteer at Bloodworks is true, accurate and complete. I understand that if I am accepted as a volunteer, any false, incomplete, misleading or inaccurate statement or omission of information on my application or that I provide Bloodworks at any time during the application process or at any time while I serve as a volunteer may result in my dismissal and/or disqualification for volunteer opportunities regardless of when discovered. I further understand that this application and any other statements by any representative of Bloodworks is not intended to be an agreement, promise or contract of employment or volunteer involvement, nor does this application create an obligation in any way to provide me with volunteer opportunities or require that I volunteer at any time at Bloodworks. By signing hereto, I fully waive any and all claims of any nature whatsoever against Bloodworks, its employees, agents, supervisors, managers, directors and assigns; and, any third party or other entity acting on Bloodworks behalf that provides Bloodworks information about me; and any outside agency utilized by Bloodworks or anyone else to obtain and communicate any information about me of any nature whatsoever. In addition, I agree to hold harmless Bloodworks, its employees, agents, assigns, supervisors, managers, directors and any third party that obtains, communicates or provides Bloodworks any information, of any nature whatsoever, about me; and any outside agency or other third party utilized by Bloodworks to obtain, communicate or provide information about me. A photocopy of this authorization shall be accepted as an original by myself, Bloodworks and all other third parties.