Job Skills & Training
Please list two (2) references that are familiar with your work life.
Disclaimer And Signature
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 misleading information in my application or interview may result in my release.
To Whom It May Concern:
I hereby authorize and request any present or former employer, school, police department, financial institution, drug screening facility or other person having personal knowledge about me, to furnish bearer with any and all information, including but not listed criminal, driving, credit history and Global Watch Alert information, in their possession regarding me in connection with an application for employment. I am willing that a photocopy of this authorization be accepted with the same authority as the original, and I specifically waive any written notice from any present or former employer who may provide information based upon this authorization request. I understand this authorization is to be part of the written employment application that I sign.
I have been given a stand-alone, consumer notification that a Consumer Report or Investigation Consumer Report will be requested and used for the purpose of evaluating me for employment, promotion, reassignment, or retention as an employee.
Consumer Reports and Investigative Consumer Reports
Disclosure Notice and Authorization
This form is to notify you that a Consumer Report and/or an Investigative Consumer Report may be obtained as part of a background check for your employment process. A "Consumer Report" is any written, oral, or other communication bearing onreputation, personal characteristics and/or mode of living. An "Investigative Consumer Report" contains information which is obtained through personal interviews with your business associates, family members, friends, neighbors, or other third parties with whom you are acquainted. This information will include inquiries regarding your personal characteristics and/or mode of living.
If any adverse employment decision is made based on the information contained in a consumer report or an investigative consumer report, you will be given a copy of the report as well as a summary of your rights under the Fair Credit Reporting Act.
By my signature below, I authorize PCG Screening Services, LLC to receive & release information in connection with my application for employment. I authorize all law enforcement agencies and courts to release all written and verbal information about me to include criminal history record information and driving license history record information. I further authorize the performance of, the procurement of and the release of consumer reports and/or investigative consumer reports which may include information about my employment and/or education. I further understand that any and all information contained in my job application may be utilized for the purpose of obtaining the consumer reports or investigative consumer reports and I confirm that all such information is true and correct. This authorization is good for 180 days from date of signature and if hired, will remain in effect for periodic background checks for the duration of my employment with this company. Facsimile and electronic signature, when used, shall be deemed legal, valid and binding upon the signing party to this agreement. I understand that I am not required to use facsimile or electronic signatures: at my option, I may elect to sign on paper and mail this form.