Mentor Background Release Form Step 1 of 3 33% Name(Required) First Last Email(Required) Enter Email Confirm Email Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code You grant SCARF Organization Inc. permission to conduct a Level II and local background check on you as a requisite component of my involvement in the mentorship program facilitated by SCARF Organization Inc. You understand and acknowledge that this background investigation may encompass, but is not restricted to, an examination of my criminal records pursuant to the statutes delineated in Florida Statutes, Chapter 435. Additionally, you authorize SCARF to disseminate the findings of this background inquiry, if necessitated, to foster care agencies or other pertinent entities affiliated with the mentorship initiative, with the express objective of ensuring the safety and welfare of both program participants and individuals under the purview of SCARF. You comprehend that all data obtained through the background screening process will be treated with the utmost confidentiality and will exclusively be accessible to duly authorized personnel involved directly in the administration of the mentorship program. Furthermore, you acknowledge that any information disclosed as a consequence of this background examination will be utilized solely for the purpose of ascertaining my suitability for participation in the mentorship program. By signing this authorization and release, you absolve SCARF, its officers, employees, and agents from any and all liability arising from the utilization and disclosure of the information garnered through the background check, to the maximum extent permitted by applicable law. This authorization and release shall remain in effect for the duration of my engagement in the mentorship program, unless explicitly revoked by me in writing. Signature(Required)Date(Required) MM slash DD slash YYYY Background Profile Information - Initiate ScreeningDate of Birth(Required) MM slash DD slash YYYY Social Security No.(Required)Place of Birth(Required)Race(Required)Black or African AmericanHispanic or LatinoWhite o CaucasianAsian or Pacific IslanderNative American or Alaskan NativeMultiracial or BiracialRace/Ethnicity not listed herePhone Number(Required)Sex(Required)MaleFemale Eye Color(Required)Hair Color(Required)Height(Required)Ex. 5-11Weight(Required)In LBSEmailThis field is for validation purposes and should be left unchanged.
