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Authorization Statement for Criminal History Record Check

I, (print your full name), hereby authorize Spark to obtain information pertaining to any charges and/or convictions I may have had for violation of municipal, county, state or federal laws. his information will include, but not be limited to, allegations regarding, and convictions for, crimes committed upon minors. I understand that this information will be gathered from any law enforcement agency of this state or any state or federal government, or from third! party providers of information originally obtained from law enforcement or court records. I understand that Spark reserves the right to rerun a criminal history record check if I volunteer in the future for Spark. I understand that I will be given an opportunity to challenge the accuracy of any information received that appears to implicate me in criminal activities. o facilitate this challenge, I will be told the nature of the information and the agency from which it was obtained. It will be my responsibility to contact that agency. I further understand that until Spark receives notification from that agency clearing me, my application will be deferred. I understand that if there is background information that may be revealed in my background check, but which I do not feel should preclude me from volunteering, I have the right to submit, in writing, a letter to Spark e"plaining the circumstances of said situation and that this letter will be considered when determining the status of my application. #s an applicant for a volunteer position, I hereby attest to the truthfulness of the representations I have made. $"cept as I have disclosed, I have not been found guilty of, or entered a plea of nolo contendre or guilty to any offense. %urther, other than for the offenses I have disclosed, I have not had a finding of delin&uency or entered a plea of nolo contendre or guilty to a petition of delin&uency under the 'uvenile laws of this state or any other state. I understand that I must be truthful and, if any statement I have made is found to be false, I will be denied the position for which I am making application or, if already accepted, terminated from my position.
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To be completed by organization:
Identification verified with government issued picture identification. (((((((((((((((((((((((

Please return to Spark Chicago: Fax (415) 354-8491

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Please return to Spark Chicago: Fax (415) 354-8491

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