Consent For Background Investigation - Volunteers - 2014


Kenai Peninsula Borough
Office of Human Resources
144 North Binkley, Soldotna, Alaska 99669 (907) 714-2130 ~ Fax (907) 714-2396
Consent for Background Investigation - Volunteers
Volunteers for the Kenai Peninsula Borough (KPB) are required to provide the information
requested on this form so the KPB can conduct a criminal background check to evaluate eligibility
to volunteer.
Your authorization below will be used exclusively by KPB Human Resources personnel solely for
the purpose of conducting a background investigation. This form, and all sensitive information, are
stored separately from your main volunteer file and are kept secured in a confidential file. If you
are selected as a volunteer, periodic background checks may be conducted throughout the time you
are an active volunteer to ensure continuing eligibility.
Please complete this information and deliver to the KPB Office of Human Resources.
Please read this document carefully before signing.
Authorization to Obtain a Criminal History Report
and Release of Information for Volunteer Purposes
I hereby authorize the Kenai Peninsula Borough and its designated agents and representatives to conduct a
comprehensive review of my background through a consumer report to be generated for evaluation of my
suitability as a volunteer for the Kenai Peninsula Borough. I understand the scope of the consumer report will
include a criminal history check, but does not include financial or medical history. In the event that a volunteer will
be driving as part of their volunteer service, driving records and related matters may be included in this record
I, ________________________________, authorize the complete release of those records or data pertaining to
me which an individual, company, firm, corporation or public agency may have. I understand that I must provide
my date of birth to adequately complete said screening and acknowledge that my date of birth will not affect any
decisions regarding volunteer eligibility if I am 18 years or older. I hereby authorize and request any present or
former employer, school, police department, financial institution or other persons having personal knowledge of
me to furnish the Kenai Peninsula Borough or its designated agents with any and all information in their
possession regarding me in connection with an application for a volunteer position. I am authorizing that a
photocopy of this authorization be accepted with the same authority as the original.
I hereby knowingly and voluntarily release the Kenai Peninsula Borough and its agents, officials, representatives
or assigned agencies, including officers, employees or related personnel, both individually and collectively, from
any and all liability for damages of whatever kind, which may at any time result to me, my heirs, family or
associates because of compliance with this authorization and request to release.
If selected as a volunteer, I understand that this authorization shall remain on file and shall serve as an ongoing
authorization to procure reports at any time during my volunteer period.
I further understand that, pursuant to the federal Fair Credit Reporting Act, if any adverse action is to be taken
based upon consumer report(s), a copy of the report and a summary of the Consumer’s Rights will be provided to
me. I understand that I have the right to dispute the accuracy of the information in a consumer report.
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