I authorize any references or organizations listed in this application to give you any information they may have regarding my character and fitness for children and youth work. I release all such references from liability for any damage that may result form furnishing such evaluations to you, and I waive any right to inspect references provided on my behalf. Should my application be accepted, I agree to be bound by the rules and regulations and policies of 2000 Strong for Christ and to act in accordance with those, in the performance of my services. I hereby attest and certify that I have never been convicted of nor pled guilty to child abuse, endangering children, gross sexual imposition, voyeurism, publice indecency, and offense of violence, or any existing or former offense of any municipal corporation, any state, United States, or any other nation that is substantially equivalent to any of the above offenses. (If you have been convicted of or pled quilty to any of the above offenses and wish to explain the circumstances therof, please do so on a separate sheet.) I further certify that I have never been discharged from employment or a volunteer position because of any activity covered by the foregoing. I hereby authorize any present or former employer, person, firm coporation, physician, or government agency to answer any and all questions and to release or provide any information within their knowledge or records, and I agree to hold any and all of them harmless and free of any liablility for releasing any truthful information that is within their knowledge and records. I furhter authorize 2000 Strong for Christ to conduct a check of my police criminal records and agree that I will fully coorperate in providing all information and signing all documents necessary to conduct such a check. I hereby attest and certify that the above information provided by me is true and correct to the best of my knowledge. I understand that misrepresentations or omissions may disqaulify my application or result in my immediate dismissal if I am already serving in a children - and youth - related position.