I, the undersigned applicant, do hereby certify that all information provided by me for the purpose of employment is true and complete to the best of my knowledge. I understand that falsification of any information on company documents may lead to denial of employment or termination.
In connection with my application for employment, I understand that investigative background inquires will be made about me that can include consumer credit, education verification, criminal convictions, motor vehicle records check, workers’ compensation, and others. These reports will include information as to my character, general reputation, work habits, performance, and experience, along with reasons for termination of employment from previous employers.
Further, I understand that you will be requesting information from various federal, state, and other agencies that maintain records concerning my past activities relating to my driving, credit, criminal, civil, and other experiences.
I authorize, without reservation, any party or agency contacted by The Multiverse LLC to furnish the above-mentioned information prior to or at any time during my employment. The information on this form will be used solely for the purpose of conducting background checks to determine employment eligibility and will be maintained in a confidential file, separate from the general personnel file.
I hereby release all of the persons and agencies providing such information from any and all claims, damages, or liabilities connected with their release of any requested information. I agree that any copy of this document is as valid as the original.
I do hereby agree to forever release and discharge The Multiverse LLC to the full extent permitted by law from any claims, damages, losses, liabilities, costs and expenses, or any other charge or complaint filed with any agency arising from the retrieval and reporting of information. According to the Federal Fair Credit Reporting Act, I am entitled to know if employment was denied based on information contained in a consumer credit report.

Applicant Information and Signature
I understand that to aid in the proper identification of my file or records, the following information is necessary.
First Name *     Last Name *       
SSN * Date of birth *