HHSC UPDATE: August 2026

I understand that Avid Home Care Solutions will conduct a State of Texas Department of Public Safety criminal history check and search the Nurse Aide Registry and the SEMARC to determine if I have a criminal conviction barring employment according to Texas Health and Safety Code, Chapter 142, section 250.006 or have committed certain conduct which would bar me from employment with vulnerable adults. If I become employed with Avid Home Care Solutions, this will also be done annually to verify continued qualification of employment.

I understand that I may not be hired if I have any criminal conviction or am listed in the Nurses Aid Registry for misconduct, or listed in the SEMARC, or the National Sex Offender Registry.

I authorize Avid Home Care Solutions to contact my professional references listed below to discuss details of my employment with an appropriate representative.

By electronically signing, I authorize Avid Home Care Solutions to conduct a background check for employment purposes. I understand that my electronic signature serves as my consent and has the same effect as a handwritten signature.

In the interest of maintaining the safety and security of our customers, employees and property, Avid Home Care Solutions will order a "consumer report" (a background report) or "investigative consumer report" on you in connection with your employment application, and if you are hired, or if you already work for Avid Home Care Solutions, may order additional background reports on you for employment purposes.

The background check company, ADP Screening and Selection Services or other background clearinghouse of the Agency's choice, will prepare the background report for Avid Home Care Solutions. ADP Screening and Selection Services is located at 301 Remington Street, Fort Collins, CO, 80524, and can be reached by phone at 800-367-5933 or at their Internet Web site address www.adpselect.com.

The background report may contain information concerning your character, general reputation, personal characteristics, mode of living, and credit standing. The types of information that may be ordered include but are not limited to: Social Security number verification; criminal, public, educational and, as appropriate, driving records checks; sex offender registries; verification of prior employment; reference, licensing and certification checks; credit reports; drug testing results; and, if applicable, worker's compensation injuries. Workers' compensation information will only be requested in compliance with federal Americans with Disabilities Act and/or any other applicable federal, state or local laws and only after a conditional job offer is made. Credit history will only be requested when permitted by law and where such information is substantially related to the duties and responsibilities of the position for which you are applying. The information may be obtained from private and public record sources, including personal interviews with your associates, friends, and neighbors. (An "investigative consumer report" is a background report that includes information from such personal interviews, except in California where that term means any background report that is not a credit report.) The nature and scope of the most common form of investigative consumer report is an investigation into your education and/or employment history conducted by ADP Screening and Selection Services or another outside organization.

You may request more information about the nature and scope of an investigative consumer report, if any, by telephoning Avid Home Care Solutions at 281-849-1949. A summary of your rights under the Fair Credit Reporting Act is also being provided to you with this form.

The Fair Credit Reporting Act gives you specific rights in dealing with consumer reporting agencies. You will find these rights summarized on A Summary of Your Rights Under the Fair Credit Reporting Act and A Summary of Your Rights Under the Provisions of California Civil Code Section 1786.22 as provided here.

After carefully reading this Background Check Disclosure and Authorization form, I authorize Avid Home Care Solutions to order my background report, including investigative consumer reports. I understand that Avid Home Care Solutions may rely on this authorization to order additional background reports, including investigative consumer reports, during my employment without asking me for my authorization again as allowed by law. I also authorize the following agencies and entities to disclose to ADP Screening and Selection Services and its agents all information about or concerning me, including but not limited to: my past or present employers; learning institutions, including colleges and universities; law enforcement and all other federal, state and local agencies; federal, state and local courts; the military; credit bureaus; testing facilities; motor vehicle records agencies; if applicable, worker's compensation injuries; all other private and public sector repositories of information; and any other person, organization, or Avid Home Care Solutions with any information about or concerning me. Workers' compensation information will only be requested in compliance with federal Americans with Disabilities Act and/or any other applicable federal, state or local laws and only after a conditional job offer is made. The information that can be disclosed to ADP Screening and Selection Services and its agents includes, but is not limited to, information concerning my employment history, earnings history, education, credit history, motor vehicle history, criminal history, military service, professional credentials and licenses and substance abuse testing. I agree that Avid Home Care Solutions may rely on this authorization to order background reports, including investigative consumer reports, from companies other than ADP Screening and Selection Services without asking me for my authorization again as allowed by law. I also agree that a copy of this form is valid like the signed original. I certify that all of the personal information I provided is true and correct.

The information requested below is collected solely for the purpose of aiding Avid Home Care Solutions in running a background check in connection with your application for employment. The employer is requesting that you provide this information to assist us in conducting a thorough background check.

I understand and agree that: Any material misrepresentation or deliberate omission of a fact in my application may result in refusal of or if employed, immediate termination from employment. Although management makes every effort to accommodate individual preference, business needs may at times make the following conditions mandatory: overtime, shift work, or a rotating work schedule. I understand and accept these as conditions of my continuing employment. It is my understanding that Name of Your Agency of will make a thorough investigation of my entire work history and may verify all data given in my application for employment, related papers, or oral interviews. I authorize such investigation and the giving and receiving of any information requested by Name of Your Agency and I release from liability any person giving or receiving such information. I agree that my employment is at will and may be terminated by Name of Your Agency or me at any time with or without notice or cause and without liability for wages or salary except such as may have been earned at the date of such termination, and that my employment is considered part-time and temporary, regardless of any assignment given to me by the agency. I further understand this is an application for employment and that no employment contract is being offered, nor will any result from my employment with Name of Your Agency. I understand that if I am employed, such employment is for no definite period of time and that Name of Your Agency can change wages, benefits, and conditions at any time. 

I understand that Name of Your Agency will perform background and employability checks through the Texas Nurse Aid Registry, SEMARC, National Sex Offender Registry and a criminal background check.  I understand that I may not be hired if I have any criminal conviction or am listed in the aforementioned.

            I acknowledge that any oral representation or written statements which may have been made to me to the contrary of this paragraph are expressly disavowed and may not be relied upon.

 

For a Summary of Your Rights Under the Fair Credit Reporting Act go to www.consumerfinance.gov/learnmore or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552. The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local protection Avid Home Care Solutions or your state Attorney General.

2