Background Check Consent

This Authorization and consent for release of personal information acknowledges that my employer and/or its agent, may now or at any time I am assigned to volunteer with or am employed by may conduct investigations whether the records are of a public, private or confidential nature. These investigations might include, but are not limited to, searches of educational institutions attended, records of previous employment, including work history, efficiency ratings, complaints and grievances filed by or against me, records from the United States criminal history information on file in local, state or federal agencies and motor vehicle records.

I understand that these searches will be used to determine work assignments or employment eligibility under the company’s employment or volunteer policies. Therefore, I authorize and consent for full release of records (verbally or in writing) to the authorized representatives of the company. After reading this document, I fully understand the contents and authorize the background verification.

1. Have you ever been convicted or plead guilty before a court of any federal, state or municipal criminal offense? (Excluding minor traffic violations) YES NO

If YES please provide an explanation:

2. Have you ever received probation or community supervision for any federal, state or municipal criminal offense? YES NO

If YES please provide an explanation:

3. As of today, do you have any pending criminal charges against you? YES NO

If YES please provide an explanation:

I hereby certify that all information provided in this authorization is true, correct and complete. I understand that if any information proves to be incorrect or incomplete that grounds for the canceling of any or all offers of employment or volunteer positions will exist and may be used at the discretion of the employer.