Authorization for Release of Information and Applicant’s Certification or Accuracy
In connection with my application for employment with the On-Site, Inc. and with my being considered for placement at a facility of
SERTA SIMMONS BEDDING (hereafter “SERTA”), I understand that SERTA may now, or at any time while I am employed conduct a consumer of investigate consumer report. I hereby release SERTA, ON-SITE, INC., and CISIVE, their officers, employees and agents, from any liability and responsibility arising from preparation of said report or investigations relating thereto. I am aware I have the right to request from CISIVE the nature and scope of any report. This authorization for release of information includes but is not limited to matters of opinion related to my character, ability and past conduct. I authorize and request all persons, schools, businesses, corporations, credit bureaus, courts and law enforcement agencies to release such information without restriction or qualification. I further authorize the release of Department of Motor Vehicle records pertaining to driver license and vehicle registration information. I authorize the National Personnel Records Center, St. Louis, MO, or any other custodian of my military record to release to CISIVE information or photocopies of my military personnel and related records. This includes a Photostat of my DD Form 214, Report of Separation.
I voluntarily waive all recourse and release all parties listed above from any liability resulting from complying with this authorization. I agree that a Photostat of this authorization is as effective and valid as the original.
I certify that all statements contained in this Request for Background Information are full, true and correct and agree that any misleading or false statement would render my application for employment void and would be sufficient cause for dismissal in the event of employment.
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