Terms: I agree that all the questions contained in this application were answered honestly and truthfully to the best
of my knowledge. All points acknowledged with my signature were done so with the full intent of abiding
by these guidelines.
I hereby give my permission for Healing Haiti to obtain information pertaining to any convictions I may have under
state and federal law. The criminal history record, as received from the reporting agencies, may include arrest and
conviction data as well as plea bargains and deferred adjudication. I understand that this information will be used,
in part, to determine my eligibility to be a volunteer with this organization. I also understand that as long as I remain
a volunteer here, the criminal history records check may be repeated at any time. I understand that I will have an
opportunity to review my criminal history report and a procedure is available for clarification, if I dispute the
record as received.
I, the undersigned, do for myself, my heirs, executors and administrator, hereby remise, release and forever discharge
and agree to indemnify Healing Haiti and each of the officers, directors, employees and agents harmless from and
against any and all causes of actions, suits, liabilities, costs, debts and sums of money, claims and demands
whatsoever, and any and all related attorneys’ fees, court costs, and other expenses resulting from the investigation
of my background in connection with my application to become a volunteer.
I understand and agree that as a part of my application, I am agreeing to be bound by the Bylaws, Doctrines and
Policies of Healing Haiti, and to refrain from unbiblical conduct in the performance of any services on behalf of this
organization. If, at any time, I am out of accord with any of these, I agree to withdraw or be withdrawn from
my serving position.
Confidentiality Statement: Information obtained as a result of the criminal background investigation will be
maintained on a confidential basis in Human Resources and may be shared with the hiring unit or applicable
upon request and/or pursuant to applicable provisions as stipulated by this policy.