ASP HH Acknowledgements and Consents

ACKNOWLEDGEMENTS AND CONSENTS OF HELPING HANDS VOLUNTEERS

I affirm that the information in my resume and any accompanying documents is true and complete to the best of my knowledge. I understand that if employed, false statements, significant omissions, or misleading information regardless of when discovered, made on or in connection with my resume and accompanying documents may result in dismissal.
I authorize investigation and verification of all information contained in my resume and any other accompanying documents as may be necessary in arriving at an employment decision.
I authorize all persons, schools, companies, former employers, and law enforcement agencies to supply any and all pertinent information and release the same from liability resulting from such information.
I acknowledge that Appalachia Service Project may request, as a condition of any offer of employment that is made or for continued employment, that | undergo a medical exam, drug testing or alcohol testing, and I consent and agree to any such exam, if required now or in the future. I understand that when drug or alcohol testing is required, a satisfactory result may be a condition of continued employment.
If accepted as a Helping Hands volunteer, I will completely read and remain familiar with the Appalachia Service Project's Rules and Regulations.
I understand that execution of this form does not indicate acceptance into the Helping Hands volunteer program. I have read and understand the above notice and voluntarily and knowingly give my consent to and acknowledge its terms.

Name*

First NameLast Name

Address*

Address

Street Address Line 2

CityState

Zip

Home Phone*

Cell Phone

Social Security Number*

Date of Birth*

Date

Signature*

Date*

Date

(Please complete this form along with the Helping Hands Covenant Form)

Appalachia Service Project | 4523 Bristol Highway | Johnson City, TN 37601
(423) 854-8800 | ASPhome.org | Rev. 8/18