PROSPECTIVE EMPLOYEE

							API       ACCESS PROFILES, INC.
          Professional Screening Service
                                                    BACKGROUND PROFILE AUTHORIZATION


I authorize Access Profiles, Inc. or any of their agents to verify the information I have provided, and to obtain the requested background history. I further
authorize law enforcement agencies, civil, criminal, and federal court systems, the military, educational institutions, former employers, corporations, and
persons to release information pursuant to this background history.

I hereby release the above mentioned sources of information from any and all liability, claim or responsibility in providing information pertaining to me.
I further expressly release Access Profiles, Inc. and its client from any liability, claim or responsibility relating to the acquisition of any information
pertaining to me.

I understand that all records developed during the investigation are the property of Access Profiles, Inc. and are released only to the client. I also
understand that I may withdraw my consent to release this information at any time. Additionally, I hereby certify that my answers to all questions are
true and complete to the best of my knowledge, and are made in good faith. I also understand that any false statements made by me will be reported to
the client. I have read and understand the authorization and release as stated above.

I authorize the release of all information to:

          NAME: ACCESS PROFILES, INC
          ADDRESS: 113 Scott Avenue, Glenshaw, PA 15116
          PHONE/FAX: (412) 486-1633/ (412) 492-7110

ANY COPY OF THIS AUTHORIZATION SHALL HAVE THE SAME AUTHORITY AS THE ORIGINAL.
I am the individual to whom the information/record applies or the parent or legal guardian of that person. I know that if I make any
representation which I know is false to obtain information from any entity, I could be punished by a fine or imprisonment, or both.


          SIGNATURE_________________________________________________________________                            DATE _______/_______/_______
          (show signatures, names, and addresses of two people if signed by mark.)


Please Print:
Last Name ___________________________________ First Name______________________________ MI _____

Maiden Name or Previous Names Used ________________________________________________

Social Security Number______________________________________ Date of Birth _______/_______/________

Address______________________________________________________________________________________

City, State, Zip__________________________________________________________
County of Residence _____________________________

For Education verification purposes: Date of Graduation (High School, GED, College) ______/______/________

Were you ever issued a drivers license?            __________Yes                 __________ No

Drivers License Number________________________________                 State Issued ___________________________
(American Driving Records to supply all driving records from, but not exclusive to, the state of Louisiana.)
*Also provide a copy of your driver’s license