IntelliCorp Authorization STAND ALONE VERS

DISCLOSURE FOR INVESTIGATIVE CONSUMER REPORT
Please Read Carefully Before Signing the Authorization

DISCLOSURE

ALLSTAFF (“The Company”) may request an investigative consumer report about you from a third party consumer reporting agency for employment (including independent contractor or volunteer assignments, as applicable).  An “investigative consumer report” is a background report that includes information from personal interviews (except in California, where that term includes background reports with or without information obtained from personal interviews).  The most common form of an investigative consumer report in connection with your employment is a reference check through personal interviews with sources such as your former employers and associates, and other information sources.  The investigative consumer report may contain information concerning your character, general reputation, personal characteristics, or mode of living.  You may request more information about the nature and scope of an investigative consumer report, if any, by contacting the Company.

You have the right, upon written request made within a reasonable time, to request (1) whether an investigative consumer report has been obtained about you, (2) disclosure of the nature and scope of any investigative consumer report and (3) a copy of your report.  These reports will be conducted by IntelliCorp Records, 3000 Auburn Drive, Suite 410, Beachwood, Ohio 44122; Tel. No. 1.888.946.8355; www.intellicorp.net.  The scope of this disclosure is all-encompassing, however, allowing the Company to obtain from any outside organization all manner of investigative consumer reports to the extent permitted by law.

ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK

I have certify I have read the foregoing Disclosure and understand it and this authorization.  I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by ALLSTAFF” at any time after receipt of this authorization and throughout my employment, if applicable.  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 IntelliCorp, 3000 Auburn Drive, Suite 410, Beachwood, Ohio 44122; Tel. No. 1.888.946.8355; www.intellicorp.net.

Please Select One:

CONSENT FOR AUTHORIZATION

authorize you to contact, through lntelliCorp Records, Inc., my current employer for Employment and Reference Verifications. (Checking "I do" will authorize inquiries to the Human Resources Department and to any listed supervisors.) 

I also consent to have any legally required notices sent electronically.

Personal Data

Current Address
Current Address
City
State/Province
Zip/Postal

SIGNATURES

(for searches conducted on minors under the age of 18).