AUTHORIZATION TO VERIFY REFERENCES
AND PERFORM EMPLOYMENT BACKGROUND INVESTIGATION

In applying for employment with ________________ (“Company”), I hereby authorize the Company, and/or any designated agent including any consumer reporting agency in the Company’s behalf, to conduct any desired background investigation of my personal history as allowed by law, and to obtain and review any criminal and civil court findings, consumer credit report, to investigate any action related to employment, and/or any investigative consumer report in conjunction with said investigation.  

I understand the nature and scope of said inquiries may include, but is not limited to, verification, inspection and/or reporting of any lawfully available records or information pertaining to work history; education; worker’s compensation claims, criminal and civil court related actions; driving history (including traffic related offenses); personal financial status including consumer credit reports; and, any other information available from any public or otherwise documented record, and/or from any past or present business, professional or personal associates, pertaining to, but not limited to, my work history, character, ethics, mode of living, and general reputation 

It is my understanding the information being obtained will not be used in violation of any federal or state equal opportunity law or regulation, and that before any adverse action is taken based upon review of any consumer credit report and/or investigative consumer report, I will be provided with a copy of said report as well as a summary of consumer’s rights.

 I hereby fully release the Company, and any and all of its employees, directors, agents, successor and assigns, and any contributing parties or sources from whom any information is obtained, from any and all claims, actions or liability whatsoever which is in any way related to this or any subsequent investigation of my personal history.

 I hereby state that all information provided by me to the Company, in any form, is, to the best of my knowledge, true, correct and complete.  I also understand that any known misrepresentation made by me to the Company will exclude me from further consideration as a candidate for employment or advancement, and may result in termination of my employment with the Company if I am hired and or advanced by the Company before such misrepresentation is identified.

I understand that acceptance of any offer or employment does not create a contractual obligation to the Company to continue to employ me in the future, and that my employment is “at-will”, for no definite period, and may be terminated at any time either by myself or the Company without previous notice.  

(Applicant)

Received by the Company: