Staff / Volunteer Background Check for Camp Rainbow

Yearly background checks are required for any volunteers that will be working directly with children.


Please complete this form in its entirety.

This will only be seen by Hospice & Palliative Care of Iredell County Human Resources. Call HR at 704-873-4719 for questions.

This will only be seen by Hospice & Palliative Care of Iredell County Human Resources. Call HR at 704-873-4719 for questions.

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List counties & state of residence other than that above, for the past seven years. If this does not apply to you, type "none".

In consideration of my application, I authorize Hospice & Palliative Care of Iredell County, Inc, by and through QPI to verify all data given by me on application, related papers or oral interviews. I understand a thorough investigation may be conducted which may include but not be limited to criminal history, motor vehicle driving record, education verification, employment history, and personal history. I hereby authorize employers, agencies, personal references and other persons with whom I am acquainted to answer all questions and release all information concerning my employment record, character, reputation, ability, education, military service, and other applicable reports. Furthermore, I release all agencies, bureaus, employers, information service organization, and individuals or companies named above from all liabilities of damages that might result from information provided in good faith. I state that the information provided by me on my application is accurate and I agree that if any information therein is found to be false at any time, my application may be discarded or my employment / volunteer service terminated. I understand that the information requested below regarding sex, race and date-of-birth are for the sole purpose of gathering the above information accurately and will not be used to discriminate against me in violation of the law. A facsimile (FAX) or photocopy of this authorization shall be as valid as the original.

I certify that all the information containedis true to the best of my knowledge. I further understand that if I am given the opportunity to begin volunteering with Hospice & Palliative Care of Iredell County, prior to the completion of my background investigation and it is determined that I gave false statements, or any omission of a material fact, I may be subject to immediate discharge.


By typing my name I agree I have read the Release of Information Statement.