AMATEURSOFTBALLASSOCIATION‐NOTICEOFBACKGROUNDCHECKANDCONSENT
IMPORTANT–PLEASEREADCAREFULLYBEFORESIGNINGBELOW
The Amateur Softball Association of America and/or its local associations (collectively, “ASA”) are volunteer driven not-for-
profit organizations. One of ASA’s objectives is to promote proper safeguards in accordance with the spirit of true
sportsmanship and establish principles for ethical behavior in the sport of softball. You are already working with ASA or you
have expressed an interest in becoming a volunteer with ASA. Consistent with promoting wholesome and safe competition,
ASA may perform criminal background and/or motor vehicle record (or “driving record”) checks on you pursuant to your
written consent and instructions below. Accordingly, ASA may obtain reports on your criminal background and/or driving
history from a “consumer reporting agency.” The report may include information gathered from county, federal, statewide or
other record searches, as guided by personal identifier information obtained through a Social Security Number trace, name
address or other information. You may refuse to provide your consent to a background check, however, your refusal may affect
your ability to participate in ASA programs. NOTE: Conducting a Social Security Trace does NOT access the subject’s credit
history nor affects the subject’s credit score or credit rating. ASA has contracted with LexisNexis, a consumer reporting agency,
to provide the consumer reports. LexisNexis may be contacted by mail at LexisNexis, P.O. Box 105108, Atlanta, GA, 30348, by
telephone at 800-845-6004 or through the internet at http://www.lexisnexis.com/ and/or http://personalreports.lexisnexis.com/
The consumer reports may contain information bearing on your character, general reputation, personal characteristics, and mode
of living. Please note that ASA does not discriminate on the basis of race, color, creed, religion, sex, sexual orientation, national
origin or ancestry. The types of information that may be obtained include but are not limited to social security number
verification, sex offender registry checks, criminal records checks, inmate records searches, motor vehicle records, and court
records checks. The information contained in these consumer reports may be obtained by LexisNexis from public record
sources. The consumer reports will not
include credit record checks. The nature and scope of the consumer reports are
described above. Nonetheless, you are entitled to request a complete and accurate disclosure of the nature and scope of such
reports by submitting a written request to LexisNexis at the address listed above. Additional notices for applicants in California,
New York, Minnesota, Maine, and Oklahoma are attached to this form.
By signing below you are authorizing and instructing ASA to immediately obtain criminal background and driving record
reports from a third party (utilizing a social security number trace or other information such as your name, address or driver’s
license number) as ASA deems necessary and appropriate. Moreover, you are allowing and instructing ASA to obtain those
reports from a third party on an ongoing basis without any additional notice or consent for as long as you are a volunteer or
otherwise associated with ASA. You may revoke this consent at any time by providing ASA with a written notice of revocation.
AUTHORIZATION,CONSENTANDINSTRUCTION
I acknowledge receipt of the Notice of Background Check and certify that I have read and understand that notice. I hereby
voluntarily consent to ASA obtaining a background check on me and I authorize and instruct ASA to obtain criminal
background and/or driving record reports from a third party (utilizing a social security number trace or other information such as
my name, address or driver’s license number) as ASA deems necessary and appropriate. This authorization and instruction will
take immediate effect when I sign below, and will last throughout the duration of my involvement with ASA. Accordingly, ASA
may obtain additional criminal background and/or driving record reports from a third party on an ongoing basis (i.e. annually or
semi-annually) throughout my association with ASA without any further notice or additional warning. To this end, I hereby
authorize without reservation any law enforcement agency, administrator, local, state or federal agency, information service
bureau and/or the Social Security Administration to furnish any and all background information (including criminal history
and/or driving records but not credit history) requested by any third party "consumer reporting agency", another outside
organization acting on behalf of ASA, and/or ASA itself. I understand that if ASA makes a preliminary determination not to
accept my application or to revoke my affiliation based on information contained in a consumer report, I will be notified and
provided an opportunity to respond. I agree that a facsimile (“fax”) or photographic copy of this Authorization and Instruction
shall be as valid as the original.
IncludeaLegiblePhotoCopyofyourDriver’sLicenseAttachedtothisdocument.
PrintedName(FullLegalame)Last,Middle,First
DateofBirth
AliasesorFormerNamesusedinpasttenyears
SignatureDate
ASAIDcardMember#
EmailaddressPhoneNumber
CurrentResidence,StreetAddress
Driver’sLicense#&State
PriorResidence(inlast5years),StreetAddress
CurrentResidence,City,State&ZipCode
DesiredPositionw/ASA
PriorResidence(inlast5years),City,State,&Zip
v.1.05‐11
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