Fill and Sign the I Name of Applicant Hereby Authorize Form

Disclosure and Authorization for Background Investigation I, _________________ (Name of Applicant), hereby authorize ___________________ (Name of Prospective Employer), (the Company), and/or any entity directed by Company to obtain an investigative consumer report and/or consumer credit report for employment purposes, including in connection with my application for employment. I understand that an investigative consumer report includes any information as to your character, general reputation, personal characteristics, or mode of living. I understand that a consumer credit report includes any information regarding your credit worthiness, credit standing, credit capacity. The specific nature and scope of the investigative consumer report Company is seeking includes inquiries regarding educational background; work history; personal financial status and credit history; court records, including criminal conviction record, as permitted by law; driving history; verifications of Social Security number; and references obtained from professional and personal associates. I further understand and agree that an investigative consumer report and/or consumer credit report may be obtained at any time, and any number of times, as Company in its sole discretion determines is necessary before, during or after my employment. The consumer reporting agency that will be providing Company with the investigative consumer report and/or consumer credit report is ________________________________ (Name of Consumer Reporting Agency). I understand that I will automatically be provided with a copy of the investigative consumer report provided to Company. I acknowledge receipt of the attached summary of an investigative consumer reporting agency’s obligations pursuant to (cite any relevant state statute) _________________________________ . I hereby authorize all previous employers, educational institutions, consumer reporting agencies and other persons or entities having information about me to provide such information to Company or other entity that obtains information for Company. I further fully release Company, its employees, officers, directors, agents, successors and assigns, and all other parties involved in this background investigation, including but not limited to investigators, credit agencies and those companies or individuals who provide information to Company concerning me, from any claims or actions for any liability whatsoever related to the process or results of the background investigation. I understand that an offer of employment is contingent upon the outcome of my background check, and that this Disclosure and Authorization is not an offer for employment by Company or a contract for employment with Company. I further understand Company operates under an AT-WILL EMPLOYMENT POLICY and this Authorization does not alter or affect that policy in any manner whatsoever. Witness my signature this the ____ day of _____________, 20____. ______________________________(Printed Name of Applicant)______________________________ (Signature of Applicant) [ ] Yes, I wish to receive a copy of any consumer credit report requested about me by Company.