Fill and Sign the Conduct Investigation Form

Consent to Conduct Background Investigation Date __________________ I am an applicant for a position with ___________________ (name of prospective employer) . I understand that in order for ________________________ (name of prospective employer) to determine my eligibility, qualifications and suitability for employment, it will have to conduct a background investigation if I am considered for an offer of employment. This investigation may include asking my current and any former employer and educational institution I have attended about my education, training, experience, qualifications, job performance, professional conduct and evaluations, as well as confirming my dates of employment or enrollment, positions held, reasons for leaving employment, whether I could be rehired, reasons for not rehiring (if applicable) and similar information. I hereby give my consent for any employer or educational institution to release any information requested in connection with this background investigation. I release, hold harmless and agree not to sue or file any claim of any kind against any current or former employer or educational institution, and any officer or employee of either, that furnishes written or oral references requested by this employer to complete its background investigation. A photocopy of this release will be valid as an original even though the photocopy does not contain an original writing of my signature. This release will expire ______ (number of months) after the date signed. Witness my signature, this ________________ (date) . _________________________________ (Printed Name of Applicant) _________________________________ (Signature of Applicant)