BACKGROUND
INVESTIGATION CONSENT
I,
________________________________________, hereby authorize
_______________________ and/or its agents to make an independent investigation
of my background, references, character, past employment, education, credit
history, criminal or police records, including those maintained by both public
and private organizations and all public records for the purpose of confirming
the information contained on my Application and/or obtaining other information
which may be material to my qualifications for employment now and, if
applicable, during the tenure of my employment with
____________________________________.
I release
_________________________________ and/or its agents and any person or entity,
which provides information pursuant to this authorization, from any and all
liabilities, claims or law suits in regards to the information obtained from any
and all of the above referenced sources used.
The following is my
true and complete legal name and all information is true and correct to the best
of my knowledge:
Full Name (Printed)
Maiden Name or Other
Names Used
Present
Address
City, State Zip
Former
Address (if applicable) City,
State Zip
Former
Address (if applicable) City,
State Zip
Former
Address (if applicable) City,
State Zip
*Date of Birth *Social
Security Number
Signature
Date
*NOTE:
The above information is required for identification purposes only, and is in no
manner used as qualifications for employment. ____________________________ is
an Equal Opportunity Employer, and does not discriminate on the basis of Sex,
Race, Religion, Age, Handicap or National Origin.
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