If approved for the board, the following information is necessary to run a background check.
I hereby certify that all information I have supplied in this volunteer application is true, complete, and
accurate. I understand that by submitting this application, I authorize inquiries to be made concerning my
suitability as a volunteer and that this application is not a guarantee that I will be accepted as a volunteer
with The Senior Connection. I also give permission for criminal background, three year MVA driving record
check and other checks, if applicable. Further, I acknowledge that participation in any Senior Connection
program as a volunteer does not constitute employment with The Senior Connection and that I am not
covered by any type of Workers’ Compensation program while performing duties associated with
volunteering. I understand that The Senior Connection does not unlawfully discriminate in employment or
volunteer appointments and no question on this application is used for the purpose of limiting or excusing
any applicant from consideration on a basis prohibited by applicable local, state, or federal law. I agree to
comply with and be bound by the agency’s safety and health rules and regulations, rules of conduct, and
any other policy and/or rule or procedure set forth by the organization.