Background And Criminal History Check Consent Form - Homestretch printable pdf download

Background and Criminal History

Check Consent Form

I, ____________________________________________________________________, am an applicant for

employment/volunteerism with Homestretch, Inc. and have been advised that as part of the application process,

the company conducts a criminal history background report that may include, but are not limited to,

employment and education verifications, personal references, personal interviews; my personal credit history;

and driving record. I do hereby consent to Homestretch the use of the information provided during the

application process in performing the background report. Homestretch has informed me that I have the right to

review and challenge any negative information that would adversely impact a decision to offer

employment/volunteerism. In addition, I have been informed that I will have a reasonable opportunity to clear

up any mistaken information reported within a reasonable time frame established within the sole discretion of

Homestretch, Inc. Under the Fair Credit Reporting Act, I have been advised that upon request I will be

provided the name, address telephone number of the reporting agency as well as the nature, substance and

source of all information.

I release Homestretch, Inc. and 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 liabilities, claims or law suits in regards to the information obtained form any and all of the above

referenced sources used. The following is my true and complete legal name and all information is true and

correct to the best of my knowledge.

Personal Information

Applicant/Employee/Volunteer Name (Last, First,

Signature (handwritten)

Middle)

Address

City

State

Zip

Date

Social Security

Date of Birth*

Race*

Gender*

Number*

*Note: The above information is required for criminal History Checks only, and is in no manner used as qualifications for

employment, internship, or service as a volunteer. Homestretch abides by all applicable state and federal employment laws.

This information is kept separate from your personnel file.

Background And Criminal History Check Consent Form - Homestretch