AGREEMENT, AUTHORIZATION, AND CONSENT FOR RELEASE OF BACKGROUND INFORMATION


Call to order 1-800-422-4848

understand that in conjunction with my application for employment, work to be performed under contract, promotion, reassignment, and/or retention, Schwartz Ventures, Inc. will use the services of an outside agency to research and verify the information I have provided on my application for employment including my personal background, character, professional standing, work history and qualifications. This agency will provide a written report of its findings to Schwartz Ventures, Inc..

Schwartz Ventures, Inc. will hire an outside agency to utilize various sources of information it deems appropriate including but not limited to: credit reporting agencies, workers compensation records including any and all injuries in compliance with the Federal ADA Act, department of motor vehicle records, criminal conviction records, current and former employers, military records, education records, professional and personal references. I agree, authorize and consent to the release and disclosure of any and all information including but not limited to the above to Schwartz Ventures, Inc., and outside agency.

I agree, authorize and consent to the procurement of a Consumer Report and/or an Investigative Consumer Report and understand that it may contain information about my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. This authorization in original or copy form shall be valid for my term of employment from the date indicated next to my signature. According to the Fair Credit Reporting Act, I will be notified by Schwartz Ventures, Inc. if employment is denied because of information obtained from a Consumer Reporting Agency. Additionally, I understand that if requested within 60 days, I will be given a full and accurate disclosure as to the nature and substance of all information provided to Schwartz Ventures,Inc..

LAW ENFORCEMENT AGENCIES AND OTHER ENTITIES FOR POSITIVE IDENTIFICATION PURPOSES REQUIRE THE FOLLOWING INFORMATION WHEN CHECKING PUBLIC RECORDS. IT IS CONFIDENTIAL AND WILL NOT BE USED FOR ANY OTHER PURPOSES.

PLEASE PROVIDE ALL RESIDENTIAL ADDRESSES FOR THE PAST 7 YEARS

Authorization for Release of Driver Related Records

I also release and discharge Madison Communications, Inc., and all of its agents and associates, any expenses, losses, damages, liabilities, or any other charges or complaints for the investigative process.  I also authorize the full release of any driver related abstract, without reservation, throughout any duration of my employment at Madison Communications, Inc.  My signature below certifies that this authorization was completed by myself and is complete and true to the best of my knowledge.

As part of the application process for Madison Communications, Inc., I understand that they may conduct an investigation of my driver's license abstract.  I understand that these records may be used for the eligibility of my employment or continued employment for the company designated below.  I authorize without reservation the full release of these records from American Driving Records to ONLINE Information Services who is acting as agent to Madison Communications, Inc.

ELECTRONIC SIGNATURE

By checking the box below labeled, "I AGREE".

(1) Acknowledge that you consent for Release of Background Information;

(2) Acknowledge that you have read and understand the Terms detailed above;

(3) Are signing this consent form using your electronic signature.

Under federal and state law, an electronic signature like this one is just as binding as manually signing a paper document.

Check to consent to background check