Common use of Liability Waiver and Indemnification Clause in Contracts

Liability Waiver and Indemnification. Furthermore, in consideration of the opportunity afforded me, with full knowledge and appreciation of the risks involved, I hereby agree to indemnify, release and hold harmless; Stetson University, Inc., its faculty, staff, trustees, officers, representatives, agents, and host organizations from all form and manner of risks inherent or relating to such activities, and I waive all claims and demands of any nature arising from my volunteer participation, campus access and related travel. I agree and understand that this liability waiver and indemnification will extend beyond the dates of this agreement. I hereby acknowledge that I have had the opportunity to review this form and have it reviewed by legal counsel if necessary. I understand the foregoing and hereby agree to be bound by same. Signature of Volunteer: ___________________________________________________ Date: _____________ Print Full Legal Name of Volunteer _______________________________________________________________ Signature of Witness___________________________________ Printed Name: ________________________________ (Date) Volunteer Phone Contacts:_______________________________________________________________________ Address: __________________________________________________________________________________________ Email:______________________________________________________ Emergency Contact Info: __________________________________________________________________________________ Background Check Completed & Approved______ MVR Completed _____ (if applicable) Approved By: _______________________________________________________ Date:____________ Xxxxx Xxxxxxxx, Director of Human Resources / Stetson University (Rev. 7/13) AUTHORIZATION FOR RELEASE OF INFORMATION Stetson University, Inc. (“Stetson” or “the University”) is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, religion, national origin, handicap, or marital status. We assure you that your opportunity for employment, volunteer services or contract services with the University depends solely upon your qualifications. You are a candidate for employment, contracted, or voluntary services at Stetson University. As a standard procedure for all individuals applying for employment, contract or voluntary work that involves direct contact with students, the University conducts appropriate background screening, including a review of a candidate’s driving record (if driving as part of your duties or services is required). As a candidate for such employment, contracted or voluntary work, we request that you complete and sign this Authorization For Release of Information Form. The form must be fully completed for the University to further consider you for employment and/or contracted or voluntary services. This information is considered confidential and will be treated as such. Applicant/Candidate Name Social Security No. Date of Birth Driver’s License No. ______ State and County of Issue Current Home Address: How long at this address:____________ Previous Address (if at current address less than 3 years): Maiden/Alias Name(s) used:___________________________________________________Date last used:____________ Position(s) Applied For In order to permit a check of your work, background and educational records, should we be aware of any changes of name or assumed name that you have previously used? Yes No. If Yes, identify names and relevant dates. Have you ever been convicted or found guilty of violating any federal, state or municipal law, other than a minor traffic violation? In answering this question, you are to consider all matters, regardless of whether adjudication was withheld or whether a nolo contendere plea was entered. Yes No. If Yes, give dates and explain. (Attach separate paper if necessary). Convictions will not necessarily disqualify you from employment, or volunteer/contracted services. ***********************************************Candidate/Applicant’s Statement*********************************************** I certify that the information presented in my employment application with Xxxxxxx, and the statements attested to on this form, are true and complete to the best of my knowledge. I hereby authorize a background search to be done, to include my driving record if applicable; and authorize the investigation of all matters pertaining to any application for employment with Stetson that I have submitted, and thereby give Stetson permission to contact schools, previous employers, references, and others, and hereby release Stetson from any liability as a result of such contact. I understand that misrepresentations, omissions of facts or incomplete information in my application for employment or this form may remove me from further consideration for employment and contracted or volunteer services. In addition, if employed, any misrepresentations or omissions of facts called for in applying for employment will be cause for dismissal at any time without any previous notice. I understand that upon employment, I am required to provide documentation verifying my identity and my legal right to work in the U.S..

Liability Waiver and Indemnification. Furthermore, in consideration of the opportunity afforded me, with full knowledge and appreciation of the risks involved, I hereby agree to indemnify, release and hold harmless; Stetson University, Inc., its faculty, staff, trustees, officers, representatives, agents, and host organizations from all form and manner of risks inherent or relating to such activities, and I waive all claims and demands of any nature arising from my volunteer participation, campus access and related travel. I agree and understand that this liability waiver and indemnification will extend beyond the dates of this agreement. I hereby acknowledge that I have had the opportunity to review this form and have it reviewed by legal counsel if necessaryat my discretion. I understand the foregoing and hereby agree to be bound by same. Signature of Volunteer: ______________________________________________________ Date: _________________ Print Full Legal Name of Volunteer _____________________________________________________________________ Signature of Witness_____________________________________ Printed Name: ________________________________ (Date) Volunteer Phone Contacts:____________________________________________________________________________ Address: __________________________________________________________________________________________ Email:_______________________________________________________________ Emergency Contact Info: _________________________________________________________________________________________________ Background Check Completed & Approved______ MVR Completed _____ (if applicable) Approved By: _______________________________________________________ Date:____________ Xxxxx Xxxxxxxx, Director of Human Resources / Stetson University (Rev. 7/134/13) AUTHORIZATION FOR RELEASE OF INFORMATION Stetson University, Inc. (“Stetson” or “the University”) is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, religion, national origin, handicap, or marital status. We assure you that your opportunity for employment, volunteer services or contract services with the University depends solely upon your qualifications. You are a candidate for employment, contracted, or voluntary services at Stetson University. As a standard procedure for all individuals applying for employment, contract or voluntary work that involves direct contact involvement with students, the University conducts appropriate background screening, including a review of a candidate’s driving record (if driving as part of your duties or services is required). As a candidate for such employment, contracted or voluntary work, we request that you complete and sign this Authorization For Release of Information Form. The form must be fully completed for the University to further consider you for employment and/or contracted or voluntary services. This information is considered confidential and will be treated as such. Applicant/Candidate Name Social Security No. Date of Birth Driver’s License No. ______ State and County of Issue Current Home Address: How long at this address:____________ Previous Address (if at current address less than 3 years): Maiden/Alias Name(s) used:___________________________________________________Date last used:____________ Position(s) Applied For In order to permit a check of your work, background and educational records, should we be aware of any changes of name or assumed name that you have previously used? Yes No. If Yes, identify names and relevant dates. Have you ever been convicted or found guilty of violating any federal, state or municipal law, other than a minor traffic violation? In answering this question, you are to consider all matters, regardless of whether adjudication was withheld or whether a nolo contendere plea was entered. Yes No. If Yes, give dates and explain. (Attach separate paper if necessary). Convictions will not necessarily disqualify you from employment, or volunteer/contracted services. ***********************************************Candidate/Applicant’s Statement*********************************************** I certify that the information presented in my employment application with Xxxxxxx, and the statements attested to on this form, are true and complete to the best of my knowledge. I hereby authorize a background search to be done, to include my driving record if applicable; and authorize the investigation of all matters pertaining to any application for employment with Stetson that I have submitted, and thereby give Stetson permission to contact schools, previous employers, references, and others, and hereby release Stetson from any liability as a result of such contact. I understand that misrepresentations, omissions of facts or incomplete information in my application for employment or this form may remove me from further consideration for employment and contracted or volunteer services. In addition, if employed, any misrepresentations or omissions of facts called for in applying for employment will be cause for dismissal at any time without any previous notice. I understand that upon employment, I am required to provide documentation verifying my identity and my legal right to work in the U.S..):

Liability Waiver and Indemnification. Furthermore, in consideration of the opportunity afforded me, with full knowledge and appreciation of the risks involved, I hereby agree to indemnify, release and hold harmless; Stetson University, Inc., its faculty, staff, trustees, officers, representatives, agents, and host organizations from all form and manner of risks inherent or relating to such activities, and I waive all claims and demands of any nature arising from my volunteer participation, campus access and related travel. I agree and understand that this liability waiver and indemnification will extend beyond the dates of this agreement. I hereby acknowledge that I have had the opportunity to review this form and have it reviewed by legal counsel if necessary. I understand the foregoing and hereby agree to be bound by same. Signature of Volunteer: ___________________________________________________ Date: ______________________ Print Full Legal Name of Volunteer _______________________________________________________________________ Signature of WitnessWitness Signature:_______________________________________ Printed Name: __________________________________ (Date) Volunteer Phone ContactsContact:___________________________________Email:_______________________________________________________________________ Address: __________________________________________________________________________________________ Email:______________________________________________________ Emergency Contact Info: __________________________________________________________________________________ Background Check Completed & Approved_:_____ MVR Completed MVR: _____ (if applicable) Approved By: ____________________________________________________________ Date:____________ Xxxxx Xxxxxxxx, Director of Human Resources / Resources/ Stetson University (Rev. 7/138-13) AUTHORIZATION FOR RELEASE OF INFORMATION Stetson University, Inc. (“Stetson” or “the University”) is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, religion, national origin, handicap, or marital status. We assure you that your opportunity for employment, volunteer services or contract services with the University depends solely upon your qualifications. You are a candidate for employment, contracted, or voluntary services at Stetson University. As a standard procedure for all individuals applying for employment, contract or voluntary work that involves direct contact with students, the University conducts appropriate background screening, including a review of a candidate’s driving record (if driving as part of your duties or services is required). As a candidate for such employment, contracted or voluntary work, we request that you complete and sign this Authorization For Release of Information Form. The form must be fully completed for the University to further consider you for employment and/or contracted or voluntary services. This information is considered confidential and will be treated as such. Applicant/Candidate Name Social Security No. Date of Birth Driver’s License No. ______ State and County of Issue Current Home Address: How long at this address:____________ Previous Address (if at current address less than 3 years): Maiden/Alias Name(s) used:___________________________________________________Date last used:____________ Position(s) Applied For In order to permit a check of your work, background and educational records, should we be aware of any changes of name or assumed name that you have previously used? Yes No. If Yes, identify names and relevant dates. Have you ever been convicted or found guilty of violating any federal, state or municipal law, other than a minor traffic violation? In answering this question, you are to consider all matters, regardless of whether adjudication was withheld or whether a nolo contendere plea was entered. Yes No. If Yes, give dates and explain. (Attach separate paper if necessary). Convictions will not necessarily disqualify you from employment, or volunteer/contracted services. ***********************************************Candidate/Applicant’s Statement*********************************************** I certify that the information presented in my employment application with Xxxxxxx, and the statements attested to on this form, are true and complete to the best of my knowledge. I hereby authorize a background search to be done, to include my driving record if applicable; and authorize the investigation of all matters pertaining to any application for employment with Stetson that I have submitted, and thereby give Stetson permission to contact schools, previous employers, references, and others, and hereby release Stetson from any liability as a result of such contact. I understand that misrepresentations, omissions of facts or incomplete information in my application for employment or this form may remove me from further consideration for employment and contracted or volunteer services. In addition, if employed, any misrepresentations or omissions of facts called for in applying for employment will be cause for dismissal at any time without any previous notice. I understand that upon employment, I am required to provide documentation verifying my identity and my legal right to work in the U.S..

Liability Waiver and Indemnification. Furthermore, in consideration of the opportunity afforded me, with full knowledge and appreciation of the risks involved, I hereby agree to indemnify, release and hold harmless; Stetson University, Inc., its faculty, staff, trustees, officers, representatives, agents, and host organizations from all form and manner of risks inherent or relating to such activities, and I waive all claims and demands of any nature arising from my volunteer participation, campus access and related travel. I agree and understand that this liability waiver and indemnification will extend beyond the dates of this agreement. I hereby acknowledge that I have had the opportunity to review this form and have it reviewed by legal counsel if necessary. I understand the foregoing and hereby agree to be bound by same. Signature of Volunteer: ___________________________________________________ Date: _____________ Print Full Legal Name of Volunteer _______________________________________________________________ Signature of Witness___________________________________ Printed Name: ________________________________ (Date) Volunteer Phone Contacts:_______________________________________________________________________ Address: __________________________________________________________________________________________ Email:______________________________________________________ Emergency Contact Info: __________________________________________________________________________________ Background Check Completed & Approved______ MVR Completed _____ (if applicable) Approved By: _______________________________________________________ Date:____________ Xxxxx Xxxxxxxx, Director of Human Resources / Stetson University (Rev. 7/134/13) AUTHORIZATION FOR RELEASE OF INFORMATION Stetson University, Inc. (“Stetson” or “the University”) is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, religion, national origin, handicap, or marital status. We assure you that your opportunity for employment, volunteer services or contract services with the University depends solely upon your qualifications. You are a candidate for employment, contracted, or voluntary services at Stetson University. As a standard procedure for all individuals applying for employment, contract or voluntary work that involves direct contact with students, the University conducts appropriate background screening, including a review of a candidate’s driving record (if driving as part of your duties or services is required). As a candidate for such employment, contracted or voluntary work, we request that you complete and sign this Authorization For Release of Information Form. The form must be fully completed for the University to further consider you for employment and/or contracted or voluntary services. This information is considered confidential and will be treated as such. Applicant/Candidate Name Social Security No. Date of Birth Driver’s License No. ______ State and County of Issue Current Home Address: How long at this address:____________ Previous Address (if at current address less than 3 years): Maiden/Alias Name(s) used:___________________________________________________Date last used:____________ Position(s) Applied For In order to permit a check of your work, background and educational records, should we be aware of any changes of name or assumed name that you have previously used? Yes No. If Yes, identify names and relevant dates. Have you ever been convicted or found guilty of violating any federal, state or municipal law, other than a minor traffic violation? In answering this question, you are to consider all matters, regardless of whether adjudication was withheld or whether a nolo contendere plea was entered. Yes No. If Yes, give dates and explain. (Attach separate paper if necessary). Convictions will not necessarily disqualify you from employment, or volunteer/contracted services. ***********************************************Candidate/Applicant’s Statement*********************************************** I certify that the information presented in my employment application with Xxxxxxx, and the statements attested to on this form, are true and complete to the best of my knowledge. I hereby authorize a background search to be done, to include my driving record if applicable; and authorize the investigation of all matters pertaining to any application for employment with Stetson that I have submitted, and thereby give Stetson permission to contact schools, previous employers, references, and others, and hereby release Stetson from any liability as a result of such contact. I understand that misrepresentations, omissions of facts or incomplete information in my application for employment or this form may remove me from further consideration for employment and contracted or volunteer services. In addition, if employed, any misrepresentations or omissions of facts called for in applying for employment will be cause for dismissal at any time without any previous notice. I understand that upon employment, I am required to provide documentation verifying my identity and my legal right to work in the U.S..

Liability Waiver and Indemnification. Furthermore, in consideration of the volunteer intern opportunity and practicum experience afforded me, with full knowledge and appreciation of the risks involved, I hereby agree to indemnify, release and hold harmless; Stetson University, Inc., its faculty, staff, trustees, officers, representatives, agents, and host organizations from all form and manner of risks inherent or relating to such activitiesactivities to include any related travel, and I waive all claims and demands of any nature arising from my volunteer voluntary internship participation, campus access and practicum experience or agreement, as well as any related traveltravel or contact with other students or practicum clients. I agree and understand that this liability waiver and indemnification will extend beyond the dates of this agreementagreement and practicum or volunteer internship activities. I hereby acknowledge that I have had the opportunity to review this form and have it reviewed by legal counsel if I deem necessary. I understand the foregoing and hereby agree to be bound by same. Signature of Volunteer/Practicum Intern: ___________________________________________________ Date: _____________ Print Full Legal Name of Volunteer ________Volunteer/Practicum Intern: _______________________________________________________ Signature of Witness___________________________________ Printed Name: ________________________________ (Date) Volunteer Volunteer/Practicum Intern Phone Contacts:_______________________________________________________________________ Address: __________________________________________________________________________________________ Email:______________________________________________________ Emergency Contact Info: __________________________________________________________________________________ Background Check Completed & Approved______ MVR Completed _____ (if applicable) Approved By: _______________________________________________________ Date:____________ Xxxxx Xxxxxxxx, Xxxxxxxx / Director of Human Resources / Resources/ Stetson University (Rev. 7/1311/13) AUTHORIZATION FOR RELEASE OF INFORMATION Stetson University, Inc. (“Stetson” or “the University”) is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, religion, national origin, handicap, or marital status. We assure you that your opportunity for employment, volunteer services or contract services with the University depends solely upon your qualifications. You are a candidate for employment, contracted, or voluntary internship services at Stetson University. As a standard procedure for all individuals applying for employment, contract or voluntary work that involves direct contact involvement with students, the University conducts appropriate background screening, including a review of a candidate’s driving record (if driving as part of your duties or services is required). As a candidate for such employment, contracted or voluntary work, we request that you complete and sign this Authorization For Release of Information Form. The form must be fully completed for the University to further consider you for employment and/or contracted or voluntary services. This information is considered confidential and will be treated as such. Applicant/Candidate Name Social Security No. Date of Birth Driver’s License No. ______ State and County of Issue Current Home Address: How long at this address:____________ Previous Address (if at current address less than 3 years): Maiden/Alias Name(s) used:___________________________________________________Date last used:____________ Position(s) Applied For In order to permit a check of your work, background and educational records, should we be aware of any changes of name or assumed name that you have previously used? Yes No. If Yes, identify names and relevant dates. Have you ever been convicted or found guilty of violating any federal, state or municipal law, other than a minor traffic violation? In answering this question, you are to consider all matters, regardless of whether adjudication was withheld or whether a nolo contendere plea was entered. Yes No. If Yes, give dates and explain. (Attach separate paper if necessary). Convictions will not necessarily disqualify you from employment, or volunteer/contracted services. ***********************************************Candidate/Applicant’s Statement*********************************************** I certify that the information presented in my employment application with Xxxxxxx, and the statements attested to on this form, are true and complete to the best of my knowledge. I hereby authorize a background search to be done, to include my driving record if applicable; and authorize the investigation of all matters pertaining to any application for employment with Stetson that I have submitted, and thereby give Stetson permission to contact schools, previous employers, references, and others, and hereby release Stetson from any liability as a result of such contact. I understand that misrepresentations, omissions of facts or incomplete information in my application for employment or this form may remove me from further consideration for employment and contracted or volunteer internship services. In addition, if employed, any misrepresentations or omissions of facts called for in applying for employment will be cause for dismissal at any time without any previous notice. I understand that upon employment, I am required to provide documentation verifying my identity and my legal right to work in the U.S...

Liability Waiver and Indemnification. Furthermore, in consideration of the opportunity afforded me, with full knowledge and appreciation of the risks involved, I hereby agree to indemnify, release and hold harmless; Stetson University, Inc., its faculty, staff, trustees, officers, representatives, agents, and host organizations from all form and manner of risks inherent or relating to such activities, and I waive all claims and demands of any nature arising from my volunteer participation, campus access and related travel. I agree and understand that this liability waiver and indemnification will extend beyond the dates of this agreement. I hereby acknowledge that I have had the opportunity to review this form and have it reviewed by legal counsel if necessary. I understand the foregoing and hereby agree to be bound by same. Signature of Volunteer: ___________________________________________________ Date: _____________ Print Full Legal Name of Volunteer _______________________________________________________________ Signature of Witness___________________________________ Printed Name: ________________________________ (Date) Volunteer Phone Contacts:_______________________________________________________________________ Address: __________________________________________________________________________________________ Email:______________________________________________________ Emergency Contact Info: __________________________________________________________________________________ Background Check Completed & Approved______ MVR Completed _____ (if applicable) Approved By: _______________________________________________________ Date:____________ Xxxxx Xxxxxxxx, Director of Human Resources / Stetson University (Rev. 7/138/13) AUTHORIZATION FOR RELEASE OF INFORMATION Stetson University, Inc. (“Stetson” or “the University”) is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, religion, national origin, handicap, or marital status. We assure you that your opportunity for employment, volunteer services or contract services with the University depends solely upon your qualifications. You are a candidate for employment, contracted, or voluntary services at Stetson University. As a standard procedure for all individuals applying for employment, contract or voluntary work that involves direct contact with students, the University conducts appropriate background screening, including a review of a candidate’s driving record (if driving as part of your duties or services is required). As a candidate for such employment, contracted or voluntary work, we request that you complete and sign this Authorization For Release of Information Form. The form must be fully completed for the University to further consider you for employment and/or contracted or voluntary services. This information is considered confidential and will be treated as such. Applicant/Candidate Name Social Security No. Date of Birth Driver’s License No. ______ State and County of Issue Current Home Address: How long at this address:____________ Previous Address (if at current address less than 3 years): Maiden/Alias Name(s) used:___________________________________________________Date last used:____________ Position(s) Applied For In order to permit a check of your work, background and educational records, should we be aware of any changes of name or assumed name that you have previously used? Yes No. If Yes, identify names and relevant dates. Have you ever been convicted or found guilty of violating any federal, state or municipal law, other than a minor traffic violation? In answering this question, you are to consider all matters, regardless of whether adjudication was withheld or whether a nolo contendere plea was entered. Yes No. If Yes, give dates and explain. (Attach separate paper if necessary). Convictions will not necessarily disqualify you from employment, or volunteer/contracted services. ***********************************************Candidate/Applicant’s Statement*********************************************** I certify that the information presented in my employment application with Xxxxxxx, and the statements attested to on this form, are true and complete to the best of my knowledge. I hereby authorize a background search to be done, to include my driving record if applicable; and authorize the investigation of all matters pertaining to any application for employment with Stetson that I have submitted, and thereby give Stetson permission to contact schools, previous employers, references, and others, and hereby release Stetson from any liability as a result of such contact. I understand that misrepresentations, omissions of facts or incomplete information in my application for employment or this form may remove me from further consideration for employment and contracted or volunteer services. In addition, if employed, any misrepresentations or omissions of facts called for in applying for employment will be cause for dismissal at any time without any previous notice. I understand that upon employment, I am required to provide documentation verifying my identity and my legal right to work in the U.S..

Liability Waiver and Indemnification. Furthermore, in consideration of the opportunity afforded me, with full knowledge and appreciation of the risks involved, I hereby agree to indemnify, release and hold harmless; Stetson University, Inc., its faculty, staff, trustees, officers, representatives, agents, and host organizations from all form and manner of risks inherent or relating to such activities, and I waive all claims and demands of any nature arising from my volunteer participation, campus access and related travel. I agree and understand that this liability waiver and indemnification will extend beyond the dates of this agreement. I hereby acknowledge that I have had the opportunity to review this form and have it reviewed by legal counsel if necessary. I understand the foregoing and hereby agree to be bound by same. Signature of Volunteer: ___________________________________________________ Date: _____________ Print Full Legal Name of Volunteer _______________________________________________________________ Signature of Witness___________________________________ Printed Name: ________________________________ (Date) Volunteer Phone Contacts:_______________________________________________________________________ Address: __________________________________________________________________________________________ Email:______________________________________________________ Emergency Contact Info: __________________________________________________________________________________ Background Check Completed & Approved_:_____ MVR Completed MVR: _____ (if applicable) Approved By: ____________________________________________________________ Date:____________ Xxxxx Xxxxxxxx, Director of Human Resources / Resources/ Stetson University (Rev. 7/137-13) AUTHORIZATION FOR RELEASE OF INFORMATION Stetson University, Inc. (“Stetson” or “the University”) is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, religion, national origin, handicap, or marital status. We assure you that your opportunity for employment, volunteer services or contract services with the University depends solely upon your qualifications. You are a candidate for employment, contracted, or voluntary services at Stetson University. As a standard procedure for all individuals applying for employment, contract or voluntary work that involves direct contact with students, the University conducts appropriate background screening, including a review of a candidate’s driving record (if driving as part of your duties or services is required). As a candidate for such employment, contracted or voluntary work, we request that you complete and sign this Authorization For Release of Information Form. The form must be fully completed for the University to further consider you for employment and/or contracted or voluntary services. This information is considered confidential and will be treated as such. Applicant/Candidate Name Social Security No. Date of Birth Driver’s License No. ______ State and County of Issue Current Home Address: How long at this address:____________ Previous Address (if at current address less than 3 years): Maiden/Alias Name(s) used:___________________________________________________Date last used:____________ Position(s) Applied For In order to permit a check of your work, background and educational records, should we be aware of any changes of name or assumed name that you have previously used? Yes No. If Yes, identify names and relevant dates. Have you ever been convicted or found guilty of violating any federal, state or municipal law, other than a minor traffic violation? In answering this question, you are to consider all matters, regardless of whether adjudication was withheld or whether a nolo contendere plea was entered. Yes No. If Yes, give dates and explain. (Attach separate paper if necessary). Convictions will not necessarily disqualify you from employment, or volunteer/contracted services. ***********************************************Candidate/Applicant’s Statement*********************************************** I certify that the information presented in my employment application with Xxxxxxx, and the statements attested to on this form, are true and complete to the best of my knowledge. I hereby authorize a background search to be done, to include my driving record if applicable; and authorize the investigation of all matters pertaining to any application for employment with Stetson that I have submitted, and thereby give Stetson permission to contact schools, previous employers, references, and others, and hereby release Stetson from any liability as a result of such contact. I understand that misrepresentations, omissions of facts or incomplete information in my application for employment or this form may remove me from further consideration for employment and contracted or volunteer services. In addition, if employed, any misrepresentations or omissions of facts called for in applying for employment will be cause for dismissal at any time without any previous notice. I understand that upon employment, I am required to provide documentation verifying my identity and my legal right to work in the U.S..

Liability Waiver and Indemnification. Furthermore, in consideration of the opportunity afforded me, with full knowledge and appreciation of the risks involved, I hereby agree to indemnify, release and hold harmless; Stetson University, Inc., its faculty, staff, trustees, officers, representatives, agents, and host organizations from all form and manner of risks inherent or relating to such activities, and I waive all claims and demands of any nature arising from my volunteer participation, campus access and related travel. I agree and understand that this liability waiver and indemnification will extend beyond the dates of this agreement. I hereby acknowledge that I have had the opportunity to review this form and have it reviewed by legal counsel if necessary. I understand the foregoing and hereby agree to be bound by same. Signature of Volunteer: ___________________________________________________ Date: _____________ Print Full Legal Name of Volunteer _______________________________________________________________ Signature of Witness___________________________________ Printed Name: ________________________________ (Date) Volunteer Phone Contacts:_______________________________________________________________________ Address: __________________________________________________________________________________________ Email:______________________________________________________ Emergency Contact Info: __:________________________________________________________________________________ Background Check Completed & Approved_:_____ MVR Completed MVR: _____ (if applicable) Approved By: ____________________________________________________________ Date:____________ Xxxxx Xxxxxxxx, Director of Human Resources / Resources/ Stetson University (Rev. 7/137-13) AUTHORIZATION FOR RELEASE OF INFORMATION Stetson University, Inc. (“Stetson” or “the University”) is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, religion, national origin, handicap, or marital status. We assure you that your opportunity for employment, volunteer services or contract services with the University depends solely upon your qualifications. You are a candidate for employment, contracted, or voluntary services at Stetson University. As a standard procedure for all individuals applying for employment, contract or voluntary work that involves direct contact with students, the University conducts appropriate background screening, including a review of a candidate’s driving record (if driving as part of your duties or services is required). As a candidate for such employment, contracted or voluntary work, we request that you complete and sign this Authorization For Release of Information Form. The form must be fully completed for the University to further consider you for employment and/or contracted or voluntary services. This information is considered confidential and will be treated as such. Applicant/Candidate Name Social Security No. Date of Birth Driver’s License No. ______ State and County of Issue Current Home Address: How long at this address:____________ Previous Address (if at current address less than 3 years): Maiden/Alias Name(s) used:___________________________________________________Date last used:____________ Position(s) Applied For In order to permit a check of your work, background and educational records, should we be aware of any changes of name or assumed name that you have previously used? Yes No. If Yes, identify names and relevant dates. Have you ever been convicted or found guilty of violating any federal, state or municipal law, other than a minor traffic violation? In answering this question, you are to consider all matters, regardless of whether adjudication was withheld or whether a nolo contendere plea was entered. Yes No. If Yes, give dates and explain. (Attach separate paper if necessary). Convictions will not necessarily disqualify you from employment, or volunteer/contracted services. ***********************************************Candidate/Applicant’s Statement*********************************************** I certify that the information presented in my employment application with Xxxxxxx, and the statements attested to on this form, are true and complete to the best of my knowledge. I hereby authorize a background search to be done, to include my driving record if applicable; and authorize the investigation of all matters pertaining to any application for employment with Stetson that I have submitted, and thereby give Stetson permission to contact schools, previous employers, references, and others, and hereby release Stetson from any liability as a result of such contact. I understand that misrepresentations, omissions of facts or incomplete information in my application for employment or this form may remove me from further consideration for employment and contracted or volunteer services. In addition, if employed, any misrepresentations or omissions of facts called for in applying for employment will be cause for dismissal at any time without any previous notice. I understand that upon employment, I am required to provide documentation verifying my identity and my legal right to work in the U.S..