As a condition of employment, I authorize Georgina Home Care LLC or any investigative service to investigate my background on a regular basis, to determine suitability for employment or to determine if continued employment is feasible. I understand that the inclusion of any false or misleading information, or omission of information on my application or during employment is based on the
State Criminal Conviction Check
National Criminal Background Check
DDS Abuse/Neglect Registry Checks
State and National Sex Offender Registry Checks
Office Inspect General Exclusions Database Check
Quality Assurance Actions List Check
Other pertinent background checks that may be deemed necessary by our state regulations.
I have reviewed this form, fully understand the intent of this authorization, and give my full consent for disclosure of all my records (whether personal or otherwise) from current and/or previous employment, educational institutions, the Department of Motor Vehicles, criminal and law enforcement agencies, and military records (which include a copy of my DD-214 Separation Form)
I fully understand that the information provided by the agent is secure only as to what was provided to them, therefore, do not hold the agent, nor Georgina Home Care LLC liable in any way. I release Georgina Home Care LLC from liability for damages that I may incur, which may result from the release/use of this information.
A photocopy of this release will be valid as the original, even though the said photocopy copy does not contain an original writing of my signature.