Motor Vehicle Law Enforcement

AUTHORIZATION FOR BACKGROUND INVESTIGATION

I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understood both of those documents. By my electronic authorization above, I consent to the release of consumer reports and investigative consumer reports prepared by ASURINT, to American Red Cross (RED CROSS). I understand that if RED CROSS accepts me as a volunteer or employee, my consent will apply throughout the duration of my volunteering or employment unless I revoke or cancel it by sending a signed letter to ASURINT Compliance Department, P.O. Box 14730, Cleveland, Ohio 44114, Fax 800-***-****, or at **********@*******.***.

I understand that, to the extent allowed by law, information contained in my application or otherwise disclosed by me before, during or after my volunteer or employment tenure, if any, may be utilized for the purpose of obtaining consumer reports or investigative consumer reports. Further, I hereby authorize ASURINT or any agent of ASURINT to contact any and all third parties, corporations, businesses, former employers, credit agencies, all government agencies, educational institutions, motor vehicle records agencies, law enforcement agencies, city, state, county, and federal courts, and military services. I also authorize the disclosure and release of information to ASURINT or any agent of ASURINT concerning my employment history, motor vehicle history and standing, criminal history, and all other information deemed relevant by ASURINT to ASURINT or any agent of ASURINT by former employers; learning institutions, including colleges and universities; all government agencies; law enforcement agencies; federal, state and local courts; the military; and, motor vehicle records agencies. Furthermore, I release and hold harmless from all liability any past or present employers, educational institutions, and any other persons giving references free of liability for the exchange of this information and any other reasonable and necessary information incident to the volunteering process. I understand that a background check will be obtained per my instructions at ASURINT.

I specifically understand that it is necessary for me to provide my date of birth to RED CROSS and ASURINT or any agent of ASURINT in order to conduct a background check on me. I hereby authorize RED CROSS and ASURINT or any agent of ASURINT to use my date of birth for the sole purpose of conducting a background check for RED CROSS in connection with my application for a volunteer or employment position. For residents of, or for jobs located in California, Minnesota and Oklahoma only: You will be provided with a free copy of any consumer reports or investigative consumer reports if you select and click the button above. You may obtain information or copies from RED CROSS's investigative report file at any time prior to your receipt of such copies, to the extent available, by contacting ASURINT Compliance Department, P.O. Box 14730, Cleveland, Ohio 44114, Fax 800-***-****, or at **********@*******.***. You may obtain information or copies from RED CROSS's investigative report file at any time prior to your receipt of such copies, to the extent available, by contacting ASURINT Compliance Department, P.O. Box 14730, Cleveland, Ohio 44114, Fax 800-***-****, or at **********@*******.***. This Disclosure and Authorization statement above, in the original, copy, or electronic form, is valid now and through the period of time EMPLOYER considers my application for a position and/or the duration of my with RED CROSS. I agree with all of the provisions contained herein and by indicating my agreement above, it is my intent to be bound by the above Disclosure and Authorization statement. I also understand that this document will be given full legal recognition as if I had signed a tangible written document. I have been given an opportunity to print a copy of this Disclosure and Authorization statement. Furthermore, I understand that if I am unable to print a copy of this Disclosure and Authorization, I may request a copy from ASURINT be mailed to me at the address provided on my application for a position. Please note: Your application will only be accepted if you accept the terms and conditions of the application process; therefore, if you do not accept, the application process will not proceed.