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Background Check Form
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HORSEPOWER Therapeutic Learning Center Community Service Volunteers- Non-Agency Requests Criminal Background Check Policy ~ requires an upfront non-refundable $30 fee. In order to ensure the safety and wellbeing of the clients, volunteers and staff at HORSEPOWER TLC, we reserve the right to disqualify or restrict the duties of any person who has been convicted of certain crimes; who pled guilty or no contest to certain crimes; who has been placed on probation or deferred adjudication for certain crimes or who we, in our sole discretion, based upon the information before us, otherwise deems as not qualified or fit to hold a staff or volunteer position. The criminal background check is one component of our staff, intern, volunteer, and/or Community Service application procedure. Appointment to a staff, internship, volunteer, or Community Service position is subject to a completed application and the satisfactory completion of a new volunteer orientation and training when appropriate. HORSEPOWER will conduct a criminal background search on all staff, instructors, interns, key volunteers, Community Service Volunteers, and others at the discretion of the Executive Director, Volunteer Coordinator, and/or HORSEPOWER's Board of Directors. HORSEPOWER performs independent searches of public records and contracts with an external vendor to conduct background checks, which include a criminal history search. The decision whether to exclude or limit a person remains at all times within the discretion of the Executive Director, Volunteer Coordinator, and/or HORSEPOWER's Board of Directors. Factors to be considered in making such determinations include, but are not limited to, the nature and severity of the criminal conduct, and the length of time since the criminal conduct occurred. HORSEPOWER's primary concern is always to safeguard the best interest of its clients, volunteers, interns, staff, visitors, and our equine partners.
Disclosure and Authorization Form for Criminal Background Check Procedures
Signature
Date
MM slash DD slash YYYY
Name
First
Middle
Last
Home Street Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
Mobile
Social Security Number
(Required)
Date of Birth
MM slash DD slash YYYY
Driver License State ID
(Required)
State Issued
(Required)
Please list other names used
Email
I wish to receive a copy of any report on me that is requested
I wish to receive a copy of any report on me that is requested
Active Screening, Inc (www.activescreening.com 14499 Dale Marby Hwy, Ste 201 Tampa, FL 33618 HORSEPOWER will maintain the confidentiality of all criminal background search information, including information regarding disqualification decisions.
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