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Background Check Authorization Form

Page 1 of 7 Background Check DISCLOSURE AND Authorization form In the interest of maintaining the safety and security of our customers, employees and property, _____ (the Company ) will order a consumer report (a Background report) or investigative consumer report" on you in connection with your employment application, and if you are hired, or if you already work for the Company, may order additional Background reports on you for employment purposes. The Background Check company, _____ (the " Background Check Company"), will prepare the Background report for the Company. The Background Check Company is located at _____, and can be reached by phone at _____ or at their Internet Web site address Background report may contain information concerning your character, general reputation, personal characteristics, mode of living, and credit standing.

BACKGROUND CHECK INFORMATION: The information requested below is collected solely for the purpose of aiding the Company in running a background check in connection with your application for employment. The employer is requesting that you provide this information to assist in conducting a thorough background check.

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