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Information Consent Form

REQUEST, AUTHORIZATION, CONSENT AND RELEASE FOR BACKGROUND INFORMATION

I, understand that in conjunction with my application for employment, will use the service of an outside agency to research and verify the information I have provided on my application for employment, including my personal background, character, professional standing, work history and qualifications. Said agency will provide a report to . uses Arizona Licensed Detective as an agent to perform background verifications.

Arizona Licensed Detective will utilize various sources of information it deems appropriate, including, but not limited to, Department of Motor Vehicles records, credit reporting agencies, criminal conviction records, current and former employers, military records, school records, professional and personal references. I request, authorize and consent to the release and disclosure of any and all information, including, but not limited to, the above to and Arizona Licensed Detective. I unconditionally release and hold harmless and and any named or unnamed corporation, company, custodian or records, or informant from any and all liability resulting from furnishing information about me.

I request, authorize and consent to the procurement of an Investigative Consumer Report, and understand that it may contain information about my background, mode of living, character and personal reputation. This authorization, in original or copy form, shall be valid for one year from the date indicated next to my signature. According to the Fair Credit Reporting Act, I will be notified by if employment is denied because of information obtained from said Information Provider. Upon written request within 60 days, I will be given a full and accurate disclosure as to the nature and substance of all information provided to . I further understand that when requesting a copy of the report, proper identification will be required, and I should direct my request to: Arizona Licensed Detective

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PLEASE PROVIDE ALL RESIDENTIAL ADDRESSES FOR THE PAST 7 YEARS

Current:
Former:
From
RELEASE FORM FOR CONSUMER REPORTS

In connection with my application for employment (including contract for services), I understand that consumer reports or investigative reports which may contain public record information, may be requested or made on me, including consumer credit, criminal records, driving record, education, prior employer verification, workers’ compensation claims, and others. These reports will include experience, along with reasons for termination of past employment. Further, I understand that you will be requesting information from various federal, state, local, and other agencies, which contain my past activities.

I hereby authorize, without reservation, any party or agency contracted by this employer to furnish the above mentioned information. I further authorize ongoing procurement of the above-mentioned reports at any time during my employment (or contract).

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