Shadowing Request

Shadowing Request
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Documents
Picture ID

Browse Files

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Please visit https://www.cbirecordscheck.com/ and request your background chec.
Please upload your CBI Colorado Background Check

Browse Files

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Background Permission
Initial below giving Angels Service Permission to run background checks as needed to verify my identify and basic background in order to protect clients during my shadowing experience. Backgrounds check include a Colorado Criminal background check and may include others as needed. *
Date of birth*
Social security number *
Statements
What is the purpose of your shadowing?*
I certify that all information provided in any documentation is true and complete. I understand that any false statements or omissions may disqualify me from further connections to Angels Service LLC. I authorize,whether listed or not, any person or agency, e.g. school, employers to information and opinions that may be useful in making a decision in accepting my services to Angels Service LLC and the community. I understand that if I am extended an offer of independent contractor or volunteer or other contract can be revoked or changed at any time with or without notice. Anyone who provides a false statement of any material fact or thing is guilty of perjury in the second degree as defined in section 18-8-503, CRS. I understand that this is a permanent statement and applies to all interactions with the agency. **

Yes
I understand that all information regarding clients is HIPAA requested and any project based shadowing must have signed approval from the client and Angels Service LLC. For more information regarding HIPAA: http://www.watchingfish.com/hipaa and http://www.watchingfish.com/CONFIDENTIALITY%20(January).pdf*

Yes
I understand that shadowing approval requires that I be in the presence of an approved agent at all times.*

Yes
Have you ever been charged or convicted of any unlawful sexual offense, or mistreatment, exploitation, neglect, or abuse of a person of any age? **
Reference 1
Reference 2
Reference 3
I hope this experience is a positive one that helps shape your future persepctives. -Serena Akinahew, Owner of Angels Service LLC
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Shadowing Request

Documents

Background Permission

Statements

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