Credit Check Consent Form

CREDIT CHECK CONSENT FORM
I hereby authorize SECUREHIRE, and/or its agents to make an independent investigation of my background, references, past employers, education, criminal police report, credit reports and driver's license records, including those maintained by both public and private organizations for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for employment purposes.

I release SECUREHIRE, and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the information obtained from any and all of the above referenced sources used.

THE FOLLOWING IS MY TRUE AND COMPLETE NAME AND ALL THE INFORMATION PROVIDED IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE
First Name*
Middle Name*
Last Name*
Other Last Names Used
Date of Birth*

MonthDayYear
Date
Social Security Number*
Sex*
Present Address*
Street
*
City, State, Zip
How Long?
Driver's License #*
State of Issue*
Your name as it appears exactly on your license*
Previous Address
Street
City, State, Zip
How Long?
Applicant Signature*

Clear
Date*

MonthDayYear
Date
I UNDERSTAND this employment credit report will show up on my credit report as a "employment or rental' credit report inquiry.
Initial

Clear
Should be Empty: