Premier Security Solutions
Criminal History Background Check
Name
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First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date Of Birth
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Month
-
Day
Year
Date
Social Security Number
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Driver's License Number
*
*
This authorization and consent for release of personal information acknowledges that premier security (hereafter referred to as "Company") may now, or at any time I am assigned to, volunteer with or am employed by this Company, conduct investigations whether the records are a public, private, or confidential nature. These investigations might include but are not limited to, search of educational institutions attended financial or credit work history, efficiency ratings, complaints and grievances filed by or against me, records and recollections of attorney at law or of other counsel, whether representing me or any other person (in either civil or criminal case in which I have been involved), records from the US Veteran's Administration, Criminal History Information of file and local, state, or federal agencies, and motor vehicle records, and following an employment offer, worker's compensation reports from either the Department of Labor, National Personnel Records, or the Industrial Commission or similar agencies under the provisions of the Fair Credit Reporting Act, as a mended, fifteen USC 1681 et.seq. I understand that these searches will be used to determine work assignment or employment eligibility under the companies employment or volunteer policies. Therefore, I authorize and consent for full release of records (either orally or in writing) to be the authorized representatives of the company and iChat regarding me for use and connection with my application for employment and or for other employment reasons. I acknowledge that I have reviewed the above notification and that I have been given a copy of this Notification and Authorization. I understand that this authorization can only be revoked in writing.
Employee Signature
*
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