PLEASE READ CAREFULLY: I give my permission to TLC, Inc. to obtain information concerning my prior employment history
from previous employers, listed references, the Department of Criminal Investigation, and the Department of Human Services as
needed. I give my permission for previous employers and the listed references to provide information concerning my employment at
their company or their experiences with me. I release all concerned from any liability in connection therewith.
My signature below indicates that I have read, understood, and agreed to the preceding statement and that I have made true, correct,
and complete answers and statements on this application. I understand that my answers and statements will be relied upon by TLC,
Inc. in considering my application, and I understand that any omission or false answer or statement made by me on this application, or
any supplements to it, will be considered cause for dismissal from volunteer opportunities.