Volunteer Background Report Disclosure and Authorization

Purpose and Use: This form is to be used for a manual background check. All information provided is confidential. You will receive notification of your volunteer status in 5-10 business days. If you have any questions, please call our Adult Screening line at 1-800-447-4475 extension 2093.

I understand that Sterling Volunteers will obtain a consumer report and/or investigative consumer report (“Report”) as part of the Volunteer background screening process. I also understand that further Reports may be obtained by Sterling VOLUNTEERS so as to update my Report.

I understand the Sterling Volunteers investigation may include obtaining information regarding my criminal record, subject to any limitations imposed by applicable federal and state law. I understand such information may be obtained through direct or indirect contact with public agencies or other persons who may have such knowledge. If an investigative consumer report is being requested, I understand such information may be obtained through any means, including but not limited to personal interviews with my acquaintances and/or associates or with others whom I am acquainted.

The nature and scope of the investigation sought is indicated by the services listed below:

·        Criminal Background Check

·        SSN Trace               

·        Sex Offender Search

·        OFAC/Terrorist Watch List

·        Motor Vehicle Report

 California Disclosure Regarding Volunteer Background Report

Girl Scouts of Northern California (“COMPANY”) may obtain from Sterling Volunteers, 113 South College Avenue, Fort Collins, CO, 80524, (855) 326-1860, www.sterlingvolunteers.com, a consumer report and/or an investigative consumer report (“REPORT”) that contains background information about you in connection with your volunteerism. Sterling Volunteers may obtain further reports throughout your volunteerism so as to update your report without providing further disclosure or obtaining additional consent.  

The REPORT may contain information about your character, general reputation, personal characteristics and mode of living. The REPORT may include, but is not limited to, credit reports and credit history information; criminal and other public records and history; public court records; motor vehicle and driving records; and Social Security verification and address history, subject to any limitations imposed by applicable federal and state law. This information may be obtained from public record and private sources, including credit bureaus, government agencies and judicial records, and other sources. If an investigative consumer REPORT is obtained, in addition to the description above, the nature and scope of any such REPORT will be personal references.

You may inspect Sterling Volunteers’ files concerning you during normal business hours and upon reasonable notice. You can inspect the files at Sterling Volunteers’ offices if you furnish proper identification, and you can obtain a copy by paying duplication costs. One other person can accompany you if he or she furnishes reasonable identification. You can also obtain a copy of your files by sending Sterling Volunteers at the address listed above a written request, including proper identification, by certified mail. Sterling Volunteers will give you a summary of the information in the files by telephone if you submit a written request including proper identification. Sterling Volunteers has trained personnel who can explain the information furnished to you, and can provide a written explanation of any coded information contained in your files. “Proper identification” includes documents such as a valid driver’s license, Social Security card, military identification card or credit card. If necessary, Sterling Volunteers may request additional information about your volunteerism and personal or family history to verify your identity.

Authorization to Obtain Volunteer Background Report

 I have read the Disclosure Regarding Volunteer Background Report provided by Girl Scouts of Northern California (“COMPANY”) and this Authorization to Obtain Volunteer Background Report. By my signature below, I hereby consent to the preparation by Sterling Volunteers, a consumer reporting agency located at 113 South College Avenue, Fort Collins, CO, 80524, (855) 326-1860, www.sterlingvolunteers.com, of background reports regarding me and the release of such reports to the COMPANY and its designated representatives, to assist the COMPANY in making a volunteer decision involving me at any time after receipt of this authorization and throughout my volunteerism, to the extent permitted by law. To this end, I hereby authorize, without reservation, any state or federal law enforcement agency or court, educational institution, motor vehicle record agency, credit bureau or other information service bureau or data repository, to furnish any and all information regarding me to Sterling Volunteers and/or the COMPANY itself, and authorize Sterling Volunteers to provide such information to the COMPANY. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original.

I acknowledge receipt of a copy of the Consumer Financial Protection Bureau’s “A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT.” *

Volunteer Information

Gender: *

Address History (Within the last seven years):


Electronic Signature

Published September 20, 2021

* Please Note: Once you submit this form, you'll have the option to print the form contents on the following page.
Girl Scouting builds girls of courage, confidence and character that make the world a better place.  2014 Girl Scouts of Northern California