INFORMATION RELEASE I, hereinafter referred to as “Recruit,” hereby authorize [COMPANY NAME], to conduct an investigative background inquiry on Recruit as a condition of initial and continued employment. This inquiry may include, but is not limited to, credit report(s), criminal history, workers’ compensation claim history, academic achievement records, and driving record, as well as other such reports pertaining to Recruit’s work habits, personal character, job performance and reason(s) for termination, where applicable. With signature below, Recruit authorizes any part of agency contracted by Company to investigate and to furnish the above listed information. Recruit further agrees to release and hold harmless of any liability all parties involved, in any manner, for any claim, injury or damage resulting from obtaining or furnishing such information, whether written or verbal. This document shall be valid in its original, faxed or copied form.
RECRUIT
(Please print name, sign above and date below) Date: FULL LEGAL NAME ___________________________________________________________ POSITION APPLIED FOR _______________________________________________________ SOCIAL SECURITY NUMBER __________________________________________________ DATE OF BIRTH ______________________________________________________________ DRIVERS LICENSE NUMBER AND STATE OF ISSUANCE __________________________ CURRENT ADDRESS __________________________________________________________ CITY, COUNTY, STATE, AND ZIP: ______________________________________________ PREVIOUS ADDRESS __________________________________________________________ CITY, COUNTY, STATE, AND ZIP: ______________________________________________