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BACKGROU UNDCHECKW WAIVER Iundersta andthatIamrequiredtofurnish f theat ttachedinform mationfortheUniversitys susein determini ingmyqualifi icationsforasamemberof o theRiverha awkShooting gSportsorgan

nization,apo osition whichhas sbeenclassifiedassensitiv vebyNorthea asternStateU University.Iunderstandt thatNortheas stern StateUniv versitysolicitsthisinforma ationandmay ysolicitaddit tionalinforma ationsoasto obeinformed dof myprevio ousrecordandcharacter.Ifurtherunde erstandanda agreethatanymisreprese entation, falsificatio on,oromissio onoffactsby ymemayconstitutegood causeforcor rrectiveaction n,uptoand includingmydisqualification,releas seordismissa al,anddiscipllinaryactionbyStudentAf ffairs. Members shipintheRiv verhawkShoo otingSportsOrganization O iiscontingentontheresult tsofsuchche ecks. Inordertoconductthe echeck,abirthdateisrequired.Please provideusw withyourbirth hdate,signth he ndreturnitto oNSUPoliceDepartment. waiver,an FullName e:__________ ___________ ____________ ___________ _B Birthdate:___ ____________ _ AnyOtherNameUsed(includingmaidenname):___________ ____________ ___________ ____________ __ CurrentHome H Address s:_________ ___________ ____________ ____________ ___________ ____________ __ Iundersta andthattheabove a informationIhavevoluntarily v pr rovidedwillbeusedsolely yforthepurpose ofabackg groundcheck k.Itwillnotbe eusedforanyotherreaso on. Signature e:Da ate:

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