In connection with my application for employment, I hereby consent and authorize either Agency or its agent, at any time during my application process and/or employment, to obtain an investigative consumer report that may include, but not be limited to:

• a criminal record check,
• employment and education verifications,
• verifications of personal references and reputation; and
• driving record.

I do hereby consent and authorize either Agency or its agent to use any information provided on the Background Check Disclosure Notice – Authorization Form or during the application process in obtaining the investigative consumer report. I have been informed that I have the right to review and challenge any negative Information that would adversely impact me or adversely affect a decision to offer employment.

I agree to release, indemnify and hold harmless either Agency or any consumer reporting agency used by either Agency with regard to any information reported by the consumer reporting agency. I understand that I am to be provided the name, address and telephone number of the consumer reporting agency and the nature and scope of the investigative report will be disclosed to me. I acknowledge that facsimile, copy or email of the Background Check Disclosure Notice – Authorization Form shall have the same validity, force and effect as the original.