Background Screening Release:
I have read and understand this agreement in its entirety. I unconditionally accept the terms and
conditions herein, including but not limited to the authorization and disqualifier language specified in the agreement. I hereby release and hold harmless Mentor Advantage, Inc., their employees, volunteers and agents, from any liability resulting from my background screen, including the specifics listed below.
I, authorize and give consent for the above named organization to obtain information regarding myself. This includes the following: Social Security Number Verification, National and State Criminal Background records/information, Drivers License and National Sex Offender Registry.
I authorize this information to be obtained either in writing, electronic transmission or via telephone in connection with my employment and/or volunteer application. Any person, firm or organization providing information or records in accordance with this authorization is released from any and all claims of liability for compliance.
Such information will be held in confidence in accordance with the organization's guidelines.
Further, I understand that it is the policy of this organization that any member who participates with
student mentees in any capacity, including Employee, Mentor, Volunteer, Intern, Board Member, and
Contract Worker applicants, shall submit to a background screen immediately upon application and
shall submit to a back ground screen every two years thereafter as long as that individual is registered
member.
Disqualifiers:
I understand that disqualification from participating in the Mentor Advantage, Inc. program and activities will result if I have been found guilty, pled guilty: or pled nolo contendere for criminal convictions for ALL Sex offenses, Murder, and Homicide regardless of time limit: Felony Violence
and Felony Drug offenses in the past 10 years; any misdemeanor violence offences in the past 7 years; any multiple misdemeanor drug and alcohol offenses with the past 7 years; or any other
crimes against children.
Any criminal conviction, finding of guilt, guilty plea or plea of nolo contendere for an offense listed above that occurs after the initial background screen has been completed will require the applicant to resubmit for a Background Screen clearance before further employment or participation.
Falsification of any information on any application or this form is grounds for denial and or immediate dismissal.
A conviction or falsification of information results in denial and or dismissal forfeits all fees paid with
application.