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Are you 18 or older?
Have you ever had actions taken against you by any government agency or private party for health care related offenses?
Have you ever had civil complaints or civil investigations against you regarding child, elder, or patient abuse?
Have you ever been convicted of a crime?

Please read the following statement carefully, then acknowledge that you have read and approved it by checking the "I Agree" checkbox at the bottom of the page, which constitutes your esignature. Please note that an esignature is the electronic equivalent of a hand-written signature.

I certify that all information in this application is true, accurate, and complete. I understand that any misrepresentation or omission of fact in this application may result in denial of volunteer opportunity. I understand and agree that submitting this application form does not automatically register me as a volunteer. I understand that I will be performing services as a volunteer without compensation. I understand and authorize Flames to Hope, Inc., directly or through an outside vendor, to obtain and investigative consumer report and request information from public and private sources, consistent with the duties of the volunteer position, about my driving record, criminal record, education, former employment, credentials, and credit. I understand that under the Fair Credit Reporting Act (FCRA), I am entitled to know if volunteering is denied based on information obtained from a consumer reporting agency. If so, I will be notified and given the name and address of the agency or the source providing the information. By indicating my agreement with this statement, I authorize to release any and all information concerning any background checks and reference checks to Flames to Hope, Inc. or its agent. Flames to Hope, Inc. does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, or any other legally protected status under local, state, and federal law. 

DO NOT E-SIGN UNTIL YOU HAVE READ THE ABOVE STATEMENT.

By my eSignature below, I certify that I have read, fully understand and accept all terms of the foregoing statement.

Please signify your acceptance by checking the "I Agree" checkbox below and then click on "Continue". After you successfully submit your application, a confirmation will be sent to the email address you have provided.

Volunteer Application

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Your contribution will make a big difference in the lives of others!

flamestohope@gmail.com  (405) 924-4380   9850 E Maguire Road Noble, Oklahoma 73068 

© 2016 Flames to Hope, Inc.

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