The Dragonfly Foundation - Background Check Release Form I, the undersigned individual, authorize the investigation of all matters contained in my application (volunteer or employment). I give The Dragonfly Foundation permission to perform a complete background check including permission to contact persons and entities listed on my application and law enforcement officials. I release The Dragonfly Foundation from any liability as a result of such contacts. I further authorize a criminal background check to be performed. I understand that misrepresentations, omissions of facts, or incomplete information requested in my volunteer application may remove me from further consideration for a volunteer position. In addition, if I am retained as a volunteer or employee, any misrepresentations, or omissions of facts called for in the application will be cause for dismissal at any time without any previous notice. Contact Details Region of InterestPlease select... Cincinnati Chicago SalutationPlease select... Ms. Mrs. Mr. First Name Last Name Each adult must submit a separate release Email Home Address City StatePlease select... AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Postal Code Mobile Phone Home Phone Are you a potential Dragonfly employee, volunteer or board member? EmployeeVolunteerBoard Member Personal Information Social Security Number Do not use dashes Birthdate Driver's License Number Have you been previously convicted of a Felony?YesNo If yes, please explain, including type of Felony, year you were convicted, and any pertinent details. After clicking submit, you will be directed to provide an e-signature that must be verified by email. reCAPTCHA helps prevent automated form spam. The submit button will be disabled until you complete the CAPTCHA. Having problems with this form? Click Here!