Laserfiche WebLink
2014 Board and Commission Application Ci.tyor <br /> Page 4 of 4 Louisville <br /> CUL`•E2:r.L ) •1 .L tt7&. <br /> I certify that the information in this application is true and complete. I understand that false <br /> statements, misrepresentations or omissions of information in this application may result in <br /> rejection of this application. The City is expressly authorized to investigate all statements <br /> contained in this application and, in connection therewith,to request a criminal history. I <br /> consent to the release of information about my ability and fitness for volunteer assignment by <br /> employers, schools, criminal justice agencies, and other individuals and organizations to <br /> investigators, personnel staffing specialists,and other authorized employees of the City of <br /> Louisville, and release all parties for all liability for any damage that may result from furnishing <br /> such information. <br /> In the event that I am selected to serve on a City of Louisville Board or Commission, I agree to <br /> comply with all of its ordinances, rules, and regulations. I fully understand and agree to provide <br /> my services to the City of Louisville as a volunteer in a voluntary capacity and that I will receive <br /> no compensation or benefits for services provided. <br /> I understand that I am NOT insured by the City of Louisville Worker's Compensation Insurance <br /> and NOT covered by any Accident Medical Insurance Policy while I am a volunteer with the City <br /> of Louisville. I authorize that all necessary first aid steps may be taken as prescribed by qualified <br /> personnel. <br /> I grant full permission to use any photographers,videotapes, recordings or any other record of <br /> my volunteer participation as a Board or Commission member. <br /> The City will provide any applicant who is rejected as a result of a background investigation <br /> information on how to obtain the report and contact information for the reporting agency. <br /> Determinations to reject an applicant as a result of the criminal background investigation report <br /> are final. <br /> BY SIGNING BELOW, I AGREE THAT I UNDERSTAND AND CONSENT TO THE ABOVE STATEMENT: <br /> Signature Date <br /> 27 <br />