Release of Background Information Agreement

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Release of Background Information Agreement

I, the undersigned, hereby authorize Truth, Inc. to conduct a complete pre-employment and periodic verification/investigation into my character, general reputation, personal characteristics, mode of living, criminal records and activities, credit reporting agencies information and documentation, driving record, vital statistics, educational records, dates of attendance, degrees earned, certificates obtained and scholastic grades achieved, employment history, personnel department documentation and/or records, personal and professional references as well as any and all information/documentation provided by me.

I hereby authorize and give my permission for the release of any and all documentation and information pertaining to me to Truth, Inc., or its assigned agent. I specifically request any information or documentation in the files of Truth, Inc., pertaining to me be released to my employers or prospective employers. I understand, give my permission and agree, that if I do not successfully complete the company’s ninety day probation period for any reason, or give a written notice of employment resignation to my supervisor at least thirty days prior to the last day of my employment, or if the company terminates my employment and/or contract, my salary or hourly wage for all compensation owed to me, by the company, shall be reduced to the base rate of the current minimum wage. I forever hold free from all harm, liability, or damage to me as a result of any person and/or firm releasing any information or documentation, Truth, Inc., employees of Truth, Inc., the person and/or agency conducting this part of the investigation, and the company and/or firm requesting and /or providing any information or documentation from any action or cause of action claim or demand for which I have now or may ever have resulting directly or indirectly or remotely from or by said Information or documentation being released, or made known. I further authorize that a photocopy or facsimile of this release can be used the same as the original.

Signature

Social Security Number

Date of Birth(Required)

Drivers License Number(Required)

State(Required)

State

Expiration Date(Required)

How long have you lived at your current address?(Required)

Current Address(Required)

Street Address Address Line 2 City State ZIP Code

Previous Address

Street Address Address Line 2 City State ZIP Code

Employers

Current Employer(Required)

Current Employer Phone(Required)

Current Employer Address(Required)

Street Address Address Line 2 City State ZIP Code

Previous Employer(Required)

Previous Employer Phone(Required)

Previous Employer Address(Required)

Street Address Address Line 2 City State ZIP Code

Have you ever been convicted of a criminal offense in the last seven (7) years?(Required)

If yes, please list ALL states, dates, and offenses.

Submitted by

For store/district:

All the required notifications have been provided to our applicant and the required authorizations are in our possession.

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Name

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