The information contained in this release and application is correct to the best of my knowledge. I authorize any references or organizations listed to provide any information, including opinions, regarding my character and fitness for work with children and youth.

In consideration of this application and release by St. John's Lutheran Church and School I hereby release any individual, church, youth organization, charity, business, employer, reference or any other person or organization from any and all liability for damage of any kind or nature which may at result to me as a result of compliance to this authorization.

Should my application be accepted, I agree to be bound by the Constitution, Bylaws and Policies of St. John's Lutheran Church and School, and to perform my services on behalf of the church in accordance with scriptural conduct.

I realize the intent of this release is to insure the safety and security of the children of St. John's Lutheran Church and School. I am aware that information regarding my criminal and personal background will be investigated. I know this information and any information received from any investigation will be held in the strictest confidence.

St. John's Lutheran Church and School is hereby authorized to verify all facts provided on my application and/or resume and to check my record with local, state and federal law enforcement agencies.