I have applied for employment/ membership with South Seneca Ambulance, Inc. As part of the application process, I understand that North Seneca Ambulance will conduct a background and reference check which may include a review of public records, criminal history checks and inquiries of my former employers and references which I have provided regarding my qualifications and suitability for employment, membership, as well as verification of any information I have provided in this application. As part of this inquiry, I understand that North Seneca Ambulance will obtain a report of criminal history information and driver license history, from applicable law enforcement agencies, or in some case the Federal Bureau of Investigation, and I hereby authorize such agencies to release any and all records and information about me to North Seneca Ambulance I also understand that the application process includes both physical and drug and alcohol test, which may also be conducted at various times throughout my employment. I hereby give my permission to any of my listed references to release to North Seneca Ambulance any information regarding my work and volunteer experience, including but not limited to performance of expected duties, and disciplinary information.
I hereby authorize South Seneca Ambulance to conduct this background and reference check, as well as the Physical and Drug and Alcohol screen as part of the application process, and I release of liability North Seneca Ambulance and its representatives for seeking, gathering and using such information. I also release any individual entity from any liability whatsoever for providing South Seneca Ambulance with any information concerning any qualification and suitability for employment or membership, including the former employers and personal references I have identified on this application.
I authorize South Seneca Ambulance to send a copy of this authorization to my listed references or anyone else contacted by the company to provide information about me.