I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

I authorize and consent to ICAN obtaining both an investigative consumer report and a consumer report on me, and I agree to submit to drug and alcohol testing in accordance with the company’s policies. I understand that this information may be used to determine whether I will be hired as an employee and, if hired, whether I will be eligible for promotions, reassignments, or retention. My signature also allows ICAN Missouri Foundation to enroll me in the Family Care Safety Registry if I am not already in the data base. This will be at ICAN’s expense. I further understand this consent will remain in effect until revoked in a written document signed by me or the separation of my employment. I further acknowledge that my refusal to provide this consent or my revoking my consent may affect my eligibility for employment, continued employment, promotion or reassignment. I further understand that the information contained on my job application or otherwise disclosed by me may be utilized for the purpose of obtaining a consumer report or investigative consumer report and certify that all such information is true and complete to the best of my knowledge. Any omissions or false or misleading statements made by me in connection with the application process will result in ICAN denying me employment, if I am hired, terminating my employment. I authorize the complete release of records or data pertaining to me which an individual, company/firm/corporation (present or past), or public agency may have to ICAN and its designated agents and representatives. I further authorize ICAN and its designated agents and representatives to disclose orally and in writing the results of this verification or interview process to authorized management within the organization. I hereby forever release ICAN and its agents, officials, representatives, or assigned agencies, including officers, employees, or related personnel both individually and collectively, to the fullest extent permitted by law from any and all liability for damages of whatever kind, or any other charge or complaint which may at any time, result to me, my heirs, family or associates arising from the retrieving and reporting of information. I understand that I must provide the following information and that no employment decisions will be solely based on this information, unless the issue relates to an essential job function or may impact the workplace and/or company.