I hereby certify that all statements made in connection with this application for volunteer work are true and complete. I understand that any false statement(s) of material facts or omissions may subject me to disqualification or dismissal. I hereby authorize the Los Angeles Police Department to obtain a record of my criminal convictions from the California Department of Justice or any other agency that maintains records of arrest and criminal convictions.
Electronically Sign by Providing Legal Name, Date of Birth and Date of Completion, EX: John Doe, 01/23/1945, 11/01/2020