Release
RELEASE TO DO REFERENCE CHECKS AND CRIMINAL RECORDS CHECK
I authorize my references, present and past employers, and any others listed in this application, to give IMAT-International Medical Assistance Team any information, including opinions, they may have regarding my character and fitness for volunteer work or employment.
This authorization, consent and release form acknowledges that IMAT may now, or at any time while employed or as a volunteer, obtain and use a back ground check on me, which may include verification of my education, previous employment/work history, driving record, and criminal record that may be in the files of the federal, state, or local criminal justice agency in any state. A photocopy or telephonic facsimile (FAX) of this Authorization and Consent for Release of Information form shall be valid as the original. The results of this verification process will be used to determine employment or volunteer eligibility. All results will be kept CONFIDENTIAL. The information obtained will NOT be provided to any parties other than to designated IMAT personnel.
I authorize Full Identity and any of their agents or designated Company Personnel, or any other company doing business with IMAT that provides background information, to release any information that pertains to any record of convictions in its file or in any criminal file maintained on me, whether local, state, or national, and to disclose orally and in writing the results of this verification process to authorized representatives.
I do hereby agree to forever release and discharge IMAT, Full Identity and their associates, and all such individuals, employers, churches, organizations, to the full extent permitted by law, from any claims, damages, losses, liabilities, costs and expenses, or any other charge of complaint arising from the retrieving and reporting of information.
In the event that information from the consumer report is utilized in whole or in part in making an adverse decision in regard to my application, before making the adverse decision, IMAT will provide me with a copy of the report and a description in writing of my rights under the law.
I hereby authorize IMAT to obtain a back ground check on me.
Volunteer:____________________
GENERAL RELEASE
In consideration of IMAT-International Medical Assistance Team arranging a volunteer assignment for me, and with the intention of binding myself, my heirs, legal representatives, successors and assigns, I hereby expressly RELEASE AND FOREVER DISCHARGE IMAT-International Medical Assistance Team, its officers, directors, employees, volunteers, agents, legal representatives, insurers, successors, and assigns from any and all claims, demands, damages, liabilities, and causes of action that I now have or may in the future have, whether known or unknown, of whatsoever nature, relating to or arising out of my selection as a volunteer by, or my service as a volunteer with, IMAT-International Medical Assistance Team whether or not due to IMAT-International Medical Assistance Team’s negligence, strict liability, or any other breach or fault. This includes, but is expressly not limited to, death, bodily injury, personal injury, property damage, loss or theft of property, economic loss, or any other damage, loss or cost.
This document shall be construed according to the laws of the state of Washington. If a dispute should arise with respect to the meaning of any of the terms of this document, the rule of construction that a document is construed against the party preparing such document shall specifically not be applicable to the interpretation of this document.
This General Release represents the entire agreement of the parties hereto and supersedes any and all prior or contemporaneous oral or written understandings, statements, representations or promises. All of the terms hereof are contractual and not mere recitals.
I acknowledge that I have carefully read this General Release, know and understand the contents thereof, and that this document was freely and voluntarily executed. I acknowledge that I was given the opportunity to seek independent legal counsel on any and all matters herein before I signed this General Release.
Volunteer: ______________________________
CONFIDENTIALITY POLICY
In the course of your volunteer work for IMAT-International Medical Assistance Team, you may have access to or hear about confidential or sensitive information. It is your responsibility not to reveal this information. Information may be used only as it pertains to your work as a volunteer, and it should not be shared with others outside IMAT-International Medical Assistance Team. Examples of confidential information include but are not limited to donor or volunteer names, telephone numbers, places of employment, financial information, or other information. Breach of this confidentiality policy may require us to terminate your volunteer status.
I agree that IMAT-International Medical Assistance Team may use my name and any photographs and video of me for publicity or promotional purposes without liability or obligation to me.
I have read and understand the IMAT-International Medical Assistance Team volunteer confidentiality policy as written above and agree to adhere to it.
Volunteer:____________________
