First Name*

Last Name*

Email*

Business Phone

Home Phone

Volunteer Organization

Volunteer Skills

Sign Proficiency*

Volunteer Availability

Birthdate

[ 4/23/2019 ]

Please confirm that you are 18 years or older. Your choice will prompt you to the application.

By my signature below, I consent to the release of consumer reports and investigative consumer reports prepared by a consumer reporting agency,Verifyi, to the Organization (“Deaf Action Center”) and its designated representatives and agents.

I understand that if the Organization accepts me, my consent will apply, and the Organization may obtain reports, throughout my volunteer term. I also understand that information contained in my volunteer application or otherwise disclosed by me before or during my volunteering, if any, may be used for the purpose of obtaining consumer reports and/or investigative consumer reports. By my signature below, I authorize law enforcement agencies, learning institutions (including public and private schools and universities), information service bureaus, credit bureaus, record/data repositories, courts (federal, state and local), motor vehicle records agencies, my past or present organizations, the military, and other individuals and sources to furnish any and all information on me that is requested by the consumer reporting agency.

By my signature below, I certify the information I provided on this form is true and correct and will be valid for any reports that may be requested by or on behalf of the Organization. I authorize DAC and its agents to contact my current employer if necessary to verify my current employment status and conduct a background check.