The Nation's Leading Provider of Employee Screening Services

Applicant Consent Form for

Pre-Employment Investigation

(Employer must keep on file for two years)

I certify and declare under penalty of perjury under relevant state and federal law that the information contained

in my employment application is complete, true and accurate. I acknowledge that falsification or omission of

information may result in immediate dismissal or retraction of any offer of employment. In consideration of

your review of my application for employment, I hereby voluntarily consent to and authorize the above employer

or its authorized agents bearing this release or copy thereof, to obtain a consumer report for employment.

I agree that this consumer report may include any of the following:

· Criminal Records

· Civil Cases

· Motor Vehicle Records

· Military Service Verification

· Credentials Verification

· Education Verification

· Employment Verification

· Personal Identity Verifications

· Past Employment Verification

· Reference Checks

· Credit Report

I authorize all persons and organizations that may have information relevant to this form to disclose such

information to the above employer or its authorized agents. I hereby release the above employer, its

authorized agents, and all persons and organizations providing information from all claims and liabilities

of any nature in connection with this research. I hereby further authorize that a photocopy of this

authorization may be considered as valid as the original. I understand that I have specific prescribed rights

as a consumer under the federal Fair Credit Reporting Act ('FCRA'), and may have additional rights under

relevant state law.

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Applicant/Employee Signature Street Address City ST Zip

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Print Name Date SSN DOB