BACKGROUND CHECK AUTHORIZATION AND RELEASE
Tip-Top Cleaningmay seek and obtain information about you from an investigative reporting agency for employment purposes. You may be the subject of investigative reports which can involve personal interviews with sources such as your current and past employers, friends, or associates. These reports may be obtained at any time after receipt of your authorization.Additionally, these reports may also be obtained if you are hired throughout the duration of your employment.You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative report. The nature and scope of the investigative reports that will be obtained with regard to your application for employment will be inthe following areas: Employment Arrest and criminal conviction These reports may be conducted by an accredited and reputable reporting agency or by another entity or person, and we may conduct some research ourselves. The scope of this notice and authorization is all-encompassing, however, allowing Tip-Top Cleaningto obtain from any outside organization all manner of investigative reports to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to consent to and request disclosure of the nature and scope of any such investigative report(s). 1. I understand that in connection with my application for employment an investigative report will be obtained. This report or these reports may contain information, but is not limited to, as to my character, general reputation, personal characteristics or mode of living, a criminal background history, verification of current and previous employment, and the additional matters indicated above and as not prohibited by law.
2. I understand that prior to taking an adverse action based, in whole or in part, on the information contained in any investigative report, a copy of the report will be provided to me. Upon written request, within a reasonable period of time after my receipt of this disclosure, a complete and accurate disclosure of the nature and scope of the investigative reports, which may involve personal interviews with sources such as neighbors, friends and associates, will be made to me. This disclosure shall be made in writing no later than 30 Days after the date on which the request for such disclosure was received or such report was first requested, whichever is later.
3. The information requested will be used in compliance with the Federal Americans with Disabilities Act (ADA) and/or any other applicable federal or state laws. Furthermore; I understand that if I am denied employment because of information contained in whole or in part in investigative reports, I have the right to be notified and given the name and address of the agency or source that provided the information.
4. I hereby authorize, without any reservation, any party be contacted by Tip-Top Cleaning or its agents, to furnish the information described in Section 1.
5. I understand that a fax, photographic or electronic copy of this consent and release shall be valid as the original.
6. I hereby release the agents and employers and all other persons, agencies, and entities providing information or reports about me from any and all liability arising out of the request for or release of any of the above-mentioned information or reports.
7. I have read and understand this form, and have been given the opportunity to consult with my independent legal advisor. By my signature below, I consent to the release of a information, as defined above, in conjunction with my application for employment and my employment. I understand that my consent will apply throughout my employment, to the extent permitted by law, unless I revoke or cancel my consent by sending a signed letter or statement to the company at any time.
____________________________________ Signature ____________________________________ Date
____________________________________ Printed Name
The following is for identification purposes only to perform the background check, and will not be used for any other purpose:
________________________ DATE ________________________________________________ PRINT NAME
_________________________________________________ SIGNATURE OF APPLICANT
___________________________________________ SOCIAL SECURITY NUMBER
___________________________________________ Date of Birth (For Background Purposes Only)
___________________________________________ Drivers License Number State
Current Address: ______________________________ ______________________________ ______________________________ ______________________________
Previous Addresses (Last 7 years): ______________________________ ______________________________ ______________________________ ______________________________
______________________________ ______________________________ ______________________________ ______________________________
______________________________ ______________________________ ______________________________ ______________________________
______________________________ ______________________________ ______________________________ ______________________________
Any other names I have been known by (including maiden name): ________________________________________________________________________ ______
________________________________________________________________________ ______
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