DISCLOSURE AND AUTHORIZATION
IMPORTANT – PLEASE READ CAREFULLY BEFORE SIGNING AUTHORIZATION DISCLOSURE REGARDING BACKGROUND INVESTIGATION

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(Your Company Name) may obtain information about you for employment purposes from a third party consumer reporting agency. Thus, you may be the subject of a “consumer report” and/or an “investigative consumer report” which may include information about your character, general reputation, personal characteristics, which can involve professional interviews with current and past employers. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records (“driving records”), verification of your education or employment history, or other background checks. Credit history will only be requested where such information is substantially related to the duties and responsibilities of the position for which you are applying. You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you, and disclosure of the nature and scope of any investigative consumer report and to request a copy of your report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment is an investigation into your education, employment history, and criminal background check. The scope of this notice and authorization is all-encompassing, thereby allowing the Company to obtain from any outside organization all manner of consumer reports and investigative consumer reports. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report. ACKNOWLEDGMENT AND AUTHORIZATION I acknowledge receipt and review of this DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT (provided on next page) and certify that I have read and understand both documents. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by the company at any time after receipt of this authorization. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by Carey Consultants, another outside organization acting on behalf of the company, and/or the company itself. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original. Further, I hereby release (Your Company Name) and any outside organization acting on behalf of the company, of any liability and responsibility in securing and compiling this background investigation and utilizing the information to assist them in making a hiring decision. I UNDERSTAND FURTHER THAT ALTHOUGH THIS IS A BACKGROUND CHECKING FORM AND NOT AN EMPLOYMENT APPLICATION, FALSIFYING ANY INFORMATION ON THIS FORM CAN LEAD TO MY IMMEDIATE DISMISSAL OR DISCONTINUATION OF MY CANDIDACY FOR ANY POSITION, CONTRACTING ASSIGNMENT, PROMOTION OR TRANSFER.