CASPER YOUTH BASEBALL

BACKGROUND INVESTIGATION CONSENT

I, __________________________________________, hereby authorize Casper Youth Baseball and/or its agents to make an independent investigation of my background, criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my Application and/or obtaining other information which may be material to my qualifications for employment now and, if applicable, during my tenure of my employment with Casper Youth Baseball.

I release Casper Youth Baseball and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the information obtained from any and all of the above referenced sources used.

The following is my true and complete legal name and all information is true and correct to the best of my knowledge:

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Full Name (Printed)

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Maiden Name or Other Names Used

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Present Address How Long?

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City/State/Zip

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Former Address How Long?

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City/State/Zip

____________ ___________________ ____________________ _____________

*Date of Birth Social Security Number Driver’s License Number State of License

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Signature Date

*NOTE: The above information is required for identification purposes only, and is in no manner used as qualifications for employment. Casper Youth Baseball is an Equal Opportunity Employer, and does not discriminate on the basis of Sex, Race, Religion, Age (40 and over), Handicap or National Origin.

Please print this form, fill it out and either fax, mail or drop it off at the CYB office with your Manager/Coach application.