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Jul 04, 2008 




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PERSONAL BACKGROUND CHECK EMPLOYMENT BACKGROUND CHECK
First Name: Last Name: State:
Address (Optional) City (Optional)


AUTHORIZATION TO CONDUCT A BACKGROUND INVESTIGATION

I hereby authorize __________________________ to make inquiries, either by written communication, by telephone, online, or in person to any present or former employer, creditor, credit bureau, government agency, educational institution, military establishment or any other persons or institutions knowledgeable of my background as to my prior history, work experience, nature of duties, work hours, wages, performance levels, reliability, responsibility, honesty and any other measures of my character or personality.

In consideration for your developing such information, I specifically waive any confidential relationship of privacy position which may exist between us and completely release you from any responsibility or liability for damages which may occur as a result of the disclosure of this information.

A photostatic, or any other copy, of this instrument bearing my signature shall be equally legally valid as the original.

DATE _____________________________________

PRINTED NAME ______________________________

SIGNATURE _________________________________

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