authorize the 100 Black Men of Greater Columbia, Inc. and/or its designee to obtain information regarding my background to include criminal record inquiries and drug testing.
I agree to hold the 100 Black Men of Greater Columbia, Inc., and/or its designee harmless regarding any information that is obtained during the background inquiry.
TO THE APPLICANT
The request for your date of birth is to be used in performing a criminal record search only. It is not used by the organization in consideration of membership. All information received on this form will be held in the strictest confidence and will be used solely by the 100 Black Men of Greater Columbia, Inc.
