Fill and Sign the Background Check Form Blank

BACKGROUND CHECK ACKNOWLEDGEMENT FORM I understand that I am entitled to a complete and accurate disclosure of the nature and scope of any investigative report of which I am the subject upon my written request to {Insert Name of Company}, if such is made within a reasonable time after the date hereof. I also understand that I may receive a written summary of my rights under 15 U.S.C. Section 1681 et. seq. I hereby release {Insert Name of Company} and any and all persons, business entities and governmental agencies, whether public or private, from any and all liability, claims and/or demands, by me, my heirs or others making such claim or demand on my behalf, for providing an investigative report hereby authorized. I understand that this Authorization/Release form shall remain in effect for the duration of my association with {Insert Name of Company}. I, the undersigned, do hereby authorize {Insert Name of Company} to procure an investigative report on me that includes social security verification and criminal history records. I further authorize any person, business entity or governmental agency who may have information relevant to the above to disclose the same to {Insert Name of Company}, including by not limited to, any and all courts, public agencies, and law enforcement agencies regardless of whether such person, business entity or governmental agency compiled information itself or received it from other sources. Signature:_______________________________________ Date: _______