Love Your Doggo Background Check

Name

First NameLast Name

Middle Name

Phone Number

Please enter a valid phone number.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Social Security Number

Driver License Number

Birth Date

MonthDayYear

Section I: Disclosure

This form, which you should read carefully, has been provided to you because the Love Your Doggo, LLC may request investigative reports on you from various public and private reporting agencies.

Investigative reports may be obtained from a background check vendor and/or public agencies and provided to Love Your Doggo. The types of information that may be obtained include but are not limited to: Social Security Number verification, criminal records checks, public court records checks, driving record checks, state tax information, etc.

Any such reports are public records under Ohio’s public records laws unless specifically exempt from disclosure.

Section II: Authorization and Release

I have carefully read and understand this Disclosure, Authorization and Release form. By my signature below, I consent to the release of investigative reports to Love Your Doggo, LLC in conjunction with my application for prospective employment. I also authorize disclosure to the Love Your Doggo, LLC and/or the background check vendor of information concerning my motor vehicle history and standing, criminal history, state tax information, and all other information the Love Your Doggo, LLC deems pertinent by any individual, corporation or other private or public entity, including without limitation to the following: law enforcement agencies; federal, state and local courts; motor vehicle records agencies; state tax agencies; and other applicable sources. I hereby release and hold the vendor and Love Your Doggo, LLC and their employees harmless from any and all liability with respect to the investigations, verifications, and/or the use of any information relevant to my employment.

I understand that if I am hired, my consent will apply throughout the term of my appointment or employment to the extent permitted by law.

This Disclosure, Authorization, and Release form, in original, faxed, photocopied, or electronic form will be valid for any reports that may be requested by Love Your Doggo, LLC.

I understand that providing any false information or omitting any material information on my resume and/or Questionnaire for Prospective Employment may be sufficient grounds for rejection of the application or termination of the employment whenever discovered.

Date

Signature