[Insert applicant name]
[Insert applicant address]
I,_______________________________ [Insert applicant name], hereby grant [Insert company name]__________________________ (the “Company”) of [Insert company address] and/or its representatives permission to investigate my background, references, character, previous employment, consumer reports, education, and criminal history record information that may be in any state or local files, including those maintained by both public and private organizations, as well as all public records, for the purpose of verifying the information on my application.
This consent may be reproduced electronically or printed off and is just as enforceable as the original.
I therefore authorize the Company to confirm the accuracy of all the data I have supplied on my application form.
I also agree to sign any additional written authorizations required for the Company to get access to and copies of records relating to this information as a condition of employment or a condition of ongoing employment.
I also grant the Company permission to view any medical information about me that may be in my records (and any other individuals who due to my employment may be covered by any Company medical or other insurance program).
Regarding the aforementioned disclosures, I hereby release any person, business, or other entity from any and all claims that would otherwise result from providing the Company with information as requested by the Company under this release.
I am aware that any fraudulent replies, assertions, or omissions I make on my application or any linked paperwork will be sufficient grounds for rejecting my application or, in the event that they are discovered after I have started working, for my immediate termination.