Background Check

NOTICE REGARDING BACKGROUND CHECK FOR VOLUNTEERS IMPORTANT

PLEASE READ CAREFULLY BEFORE SIGNING AUTHORIZATION

High Horses Center for Equine-Assisted Services (“High Horses”) intends to conduct a criminal background check to help determine whether you are a suitable candidate to provide volunteer services to High Horses. If you are applying for or being considered for a change of assignment, High Horses may conduct an additional background check with permission through a separate authorization form. Upon your execution of the following Authorization, High Horses may obtain certain background information from an outside agency. Execution of the following Authorization is a required step to volunteer at High Horses. If High Horses intends to use any information obtained through this background check in whole or in part in making an adverse decision regarding your request to volunteer, High Horses will provide you with (1) a copy of your background report and (2) a written summary of your rights under the Fair Credit Reporting Act before making the adverse decision.

AUTHORIZATION: I acknowledge receipt of the NOTICE REGARDING BACKGROUND CHECK (“the NOTICE”), and certify that I have read and understand the NOTICE and this Authorization.

I hereby authorize High Horses Center for Equine-Assisted Services to obtain a criminal background check about me from an outside agency for purposes of evaluating any aspect of my status to volunteer at High Horses.

Please reach out to volunteer@highhorses.org if you have any questions regarding the forms.

Signature (Type Name)

First Name

Last Name

Date

MM

DD

YYYY

Date Of Birth

MM

DD

YYYY

Current Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

FORMER ADDRESS IF AT CURRENT ADDRESS LESS THAN 3 YEARS

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email

OTHER NAMES USED

Have you been convicted of a crime classified as a felony or misdemeanor that has not been expunged by a court?

Yes

No

If yes, please list all felony and misdemeanor convictions that have not been expunged by a court, including convictions by court martial and driving under the influence.

Failing to disclose information will preclude you from volunteering your services at High Horses.

For each offense, state the nature, location, date, and penalty (you do not need to list parking or speeding tickets). A conviction record will not necessarily preclude you from volunteering your services with High Horses.

Please reach out to volunteer@highhorses.org if you have any questions regarding the forms.

Volunteer Forms

Background Check