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2014 Board and Commission Application <br />Page 4of4 <br />Cite.,. <br />Louisville <br />certify that the information in this application is true and complete, 1 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 1 any 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 o 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 />Date <br />it (1(°7/3 <br />