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Background Inquiry Agreement

I understand that this agreement is an authorization to any of my present or former employers or any education institution, governmental agency, or personal reference to release any information regarding my character, ability, reputation, past conduct, or job qualifications. This investigation may include, but is not limited to, the following areas: (1) Education; (2) Military History; (3) Employment History; (4) Driver’s History; and/or (5) Court, Criminal, Police or FBI records.

I hereby agree that, as a condition of consideration for volunteering with Southwest Key I am hereby authorizing, without reservation, Southwest Key, its representatives, employees or agents, to conduct an investigation of all statements contained in my volunteer application, any resume, or any other document or information that I have submitted. I hereby waive any and all rights and claims I may have against: (1) Southwest Key, its representatives, employees or agents, for seeking, gathering, and using such information; and (2) all other persons, corporations or other entities for furnishing such information about me. I authorize all results from the background inquiry to be forwarded to any funding source of Southwest Key Programs, Inc.

I understand that any false statement or misrepresentation on this document may be cause for refusal of my application to volunteer, or for immediate dismissal upon discovery regardless of when such falsification or misrepresentation is discovered.

E-Signature

Your Information

Have you ever been convicted or pled guilty, no contest or solo contender, or received deferred adjudication, or probation for: (1) any felony, at any time; (2) any crime involving violence or bodily injury, at any time; and/or (3) any misdemeanor in the past ten (10) years? Please do not include traffic violations.

Failure to provide information regarding your conviction or deferred adjudication on this document may be cause for refusal of my application to volunteer, or for immediate dismissal upon discover regardless of when such falsification or misrepresentation is discovered.

Address History

Please provide the following information regarding all locations in which you have resided for the past seven years. All periods of time must be accounted for and all residences must be listed. For each address in the past seven year include the:
- time period you lived there. From Month/Year - To Month/Year
- street address, city, county and zip

If you do not recall all of your addresses for the past seven years, please use this box to list each address that you can recall, as well as each city and state you have lived in during the past seven years.

Current Address

Previous Addresses

* Required information