Volunteer Application - Ymca Of Greater Long Beach Page 3
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5YMCA OF GREATER LONG BEACH
VOLUNTEER DISCLOSURE AUTHORIZATION
P.O. Box 90995
Long Beach, CA 90809-0995
Phone: (562) 279-1700
Fax: (562) 279-1705
As part of the application process for employment with the YMCA of Greater Long Beach, I understand that the
YMCA of Greater Long Beach and/or its agents may conduct an investigation of my personal information. The
investigation might include, but is not limited to names and dates of previous/current employment, work
experience, workers' compensation claims, criminal history records (from state, federal and other agencies),
motor vehicle records, military records, names and dates of education institutions, credit history, and
bankruptcy records. I understand that these records may be used for the eligibility of my employment. I
authorize without reservation the full release of these records and for the YMCA of Greater Long Beach and/or
those parties contacted by the YMCA of Greater Long Beach to obtain information.
In addition, I release and discharge the YMCA of Greater Long Beach, and all of its agents and associates, any
expenses, losses, damages, liabilities, or any other charges or complaints for the investigative process. I also
authorize the full release of the information described above, without any reservation, throughout any duration
of my employment at the YMCA of Greater Long Beach. I also certify that all information provided is correct and
complete on the application and my resume to the best of my knowledge. Any false statements or omissions will
be considered just cause for termination of employment.
Upon Request, the YMCA of Greater Long Beach will supply a copy of my report and my rights under the Fair
Credit Reporting Act. Requests may be directed to: YMCA of Greater Long Beach, P.O. Box 90995, Long Beach,
CA 90809-0995, or at: (562) 425-9986.
Volunteer’s Full Name: ______________________________________________________________________
Signature:__________________________________________________ Date: _________________________
Date of Birth: ______________ (This is used for criminal and driving records, month and day only)
Social Security Number: ____ - ____ - _____ Driver's License Number: __________________ State:
________
Current Address: ________________________________________________ Length of Residency: _________
Street Address, City, State, Zip
Dates
Street Address
City
State
Zip
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