VITA Volunteer Application

I authorize the investigation of all statements contained herein and understand that any document relevant to this information may be reviewed by the agents of United Way of Kenosha County.  I understand that I may not begin volunteering until the background investigation has been completed.  I certify that the answers given by me in this disclosure statement are complete, true, and correct without misrepresentations or omissions of any kind.  I further understand that the making of any false or misleading statement or omission from or on this disclosure, or any other document, will be used to deny me volunteer work, or, if currently volunteering, used to terminate my volunteer status.  I consider the request for disclosure of pending charges and convictions ongoing and will notify United Way of Kenosha County of any changes to the statements contained herein. I understand that United Way of Kenosha County shall not be held liable in any respect if my volunteering is terminated because of false of incomplete statements, answers or omissions made by me on the disclosure form of any other document. In consideration of United Way of Kenosha County’s review of the document, I hereby release United Way of Kenosha County, its Board, its agents, as well as all providers of information from any liability and for any damage which may result from the furnishing and receiving of information. A copy of this authorization and release is as valid as the original and should be recognized as such.