(Must be at least 21 years old with a clean driving record) Please Complete the Employment/Volunteer application below. 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MM DD YYYY I herby authorize the potential employer to request and review the status of my Driver's License and motor vehicle records:* Yes, I DO Authorize Buffalo PAL to Check my Driver's License NO, I DO Authorize Buffalo PAL to Check my Driver's License NOTICE – BACKGROUND INVESTIGATION In connection with your employment with The Police Athletic League of Buffalo (the “Company”), notice is hereby given that a consumer report and/or investigative consumer report may be obtained from a consumer reporting agency for employment purposes. These reports may contain information about your character, general reputation, personal characteristics and mode of living, whichever are applicable. They may involve personal interviews with sources such as your neighbors, friends or associates. The reports may also contain information about you relating to your criminal history, credit history, driving and/or motor vehicle records, education or employment history, or other background checks. You have the right, upon written request made within a reasonable time after the receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report prepared by contacting the Company and Active Screening, Inc., 14499 N. Dale Mabry Hwy., Suite 201 South, Tampa, FL 33618; Phone: 1-800-319-5580. For information about Active Screening, Inc.’s privacy practices, see www.activescreening.com. The scope of this notice and below authorization is not limited to the present and, if you are hired, will continue throughout the course of your employment and allow the Company to conduct future screenings for retention, promotion or reassignment, as permitted by law and unless revoked by you in writing. ACKNOWLEDGEMENT AND AUTHORIZATION By signing below I hereby authorize the obtaining of consumer reports and/or investigative consumer reports by the Company at any time after receipt of this authorization and throughout the course of my employment, if applicable. Potential Employee Initials below*STATE LAW NOTICES AND DISCLOSURES – BACKGROUND INVESTIGATION Pursuant to state law, the following disclosures are provided to state residents. Check box to receive report □ NEW YORK applicants or employees only: You have the right to inspect and receive a copy of any investigative consumer report requested by the Company by contacting Active Screening, Inc., 14499 N. Dale Mabry Hwy., Suite 201 South, Tampa, FL 33618; Phone: 1-800-319-5580. NEW YORK applicants or employees only: By signing below, you acknowledge receipt of a copy of Article 23-A of the New York Correction Law. Potential Employee Initials below*Potential Employee Please Type Your FULL NAME*Date of Birth* MM DD YYYY Please Type in The Last 4 digits of your SSN#*I have experience/interest in the following sports: Agency will provide paid professional development in all sports** Select All Basketball Baseball/Softball Boxing Golf Tennis Floor Hockey/ Ice skating Soccer Swimming / Lifegurard Running/ Track & Field /Cross Country Volleyball OTHER Name of Reference #1* First Last PhoneName of Reference #2* First Last PhoneName of Reference #3* First Last PhonePlease Upload your Resume* Highly RecommendedConsent* I agree that all of the information provided is truthful.