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Please include numerical designations.
I verify that the above information is accurate to the best of my knowledge.
I give the Medical Reserve Corps of Onslow County permission to inquire into my educational
background, licenses, police records, and employment and/or volunteer history. I also give permission to
the holder of any such information to release it to the Medical Reserve Corps of Onslow County.
I hold the Medical Reserve Corps of Onslow County harmless of any liability, criminal or civil,
that may arise as a result of the release of this information about me. I also hold harmless any individual
or organization that provides information to the above-named agency.
I understand that the Medical Reserve Corps of Onslow County will use this information only as part of
its verification of my volunteer application.
Medical Reserve Corps of Onslow County
1180 Commons Drive North
Jacksonville, NC 28546
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