I hereby authorize the addressed individual, company, or institution (which I have identified to St. Joseph Healthcare as part of my application process) to furnish St. Joseph Healthcare with any information they may have concerning me on record or otherwise, and I hereby release the individual, company or institution, and all individuals connected therewith from any and all liability for furnishing such information. I understand that this information is to be released in confidence and will not be shared with me, and I now waive any right to review it.

I also hereby authorize St. Joseph Healthcare and/or its related organizations or their agents to conduct a background check utilizing the exclusion list provided by the United States Department of Human Services Office of Inspector General, to conduct a criminal record background check concerning me from public sources, and a check of my employment and educational references.

I certify that answers given herein are true and complete. I understand that false, incomplete or misleading information given in my application or interview(s) may cause denial of employment or discharge from volunteer placement.

I authorize investigation of all statements contained in this application for volunteer placement. I authorize you to contact prior employers and references I have given. I release all such persons from liability to me for proving any information, to induce them to respond candidly to such inquiries. I authorize St. Joseph Healthcare or related organizations to obtain any criminal record information from public sources, as well as to obtain employment and educational references.

My electronic submission of this application shall have the same force and effect as my written signature.

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