State / Province
In connection with my seeking employment with Camp Haverim, the undersigned hereby authorizes Camp Haverim to conduct a criminal background check or checks on the undersigned. To facilitate the criminal background check(s), I hereby authorize and request that any law enforcement agency, or other persons having personal knowledge or information about me, furnish to Camp Haverim or its authorized agent, al information in their possession regarding any criminal convictions I may have. Please furnish the requested information to Camp Haverim by photocopy, facsimile, electronically or in any other form requested by Camp Haverim. I acknowledge and agree that all copies will have the same authority and authenticity as the original.
I hereby certify that I am 18 or older and that any misrepresentation, falsification or omission of facts herein, in my employment application or in any other document I provide to Camp Haverim may be considered for rescinding an offer of employment, termination of employment, and/ or denial of consideration for future employment.
In witness whereof, the undersigned has caused this document to be signed and delivered as of the date written below.