- In connection with my employment/application for employment with STAR FURNITURE, I fully understand this release acknowledges that STAR FURNITURE and/or LIBERTY SCREENING SERVICES, LTD, may now, of at any time while I am employed, conduct a public record(s)/research report containing information for verification of prior employment (including names and dales of previous employers, reason for termination of employment, work experience, accidents, etc.), academic achievement, financial history, use of a motor vehicle and driving record, worker's compensation claims, credit, bankruptcy proceedings, criminal records, general background and personal character, from federal, state and other agencies which maintain such records; as well as information from Liberty concerning previous driving record requested made by others from such state agencies, and state provided driving records.
- All background information obtained shall be utilized to assist in verification of the employment application and post job offer medical inquiry. Retrieval and usage of this information complies with the Equal Opportunity Commission, Americans With Disabilities Act and the Fair Credit Reporting Act (Laws, Rules and Regulations), as amended 9130197. STAR FURNITURE is an Equal Opportunity Employer and does not discriminate as to race, color, gender, national or religious origin, age or Americans with disabilities. I hereby declare that the answers to the questions of my application and related paperwork which I have been asked to complete, and any attachments to same, are true and correct and that any misstatements of fact(s) or omission(s) may form the basis for rejection of my application, or for my dismissal after employment.
- I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY LIBERTY SCREENING SERVICES, LTD. TO FURNISH THE ABOVE MENTIONED INFORMATION. I AUTHORIZE A FAX OR EMAIL COPY OF THIS RELEASE TO BE CONSIDERED AS EFFECTIVE AS THE ORIGINAL. ALL RESULTS WILL BE PROPRIETARY AND HELD CONFIDENTIAL AND WILL NOT BE PROVIDED TO ANY PARTIES OTHER THAN STAR FURNITURE OR ITS LEGAL REPRESENTATIVES. I VOLUNTARILY WAIVE ALL RECOURSE AND RELEASE THE REQUESTED PARTIES FROM LIABILITY FOR COMPLYING WITH THE REQUESTED RELEASE. I AUTHORIZE LIBERTY SCREENING SERVICES. LTD. TO PROVIDE THE RESULTS OF SAID INFORMATION TO STAR FURNITURE OR ITS REPRESENTATIVE(S). I FURTHER RELEASE STAR FURNITURE AND LIBERTY, AS WELL AS THEIR REPRESENTATIVES, OFFICERS, EMPLOYEES AND AGENTS. FROM ANY AND ALL LIABILITY FROM THE RESULTS AND PREPARATION OF ANY REPORTS CONCERNING MYSELF OR MY BACKGROUND. THE FACTS SET FORTH BY ME IN THIS APPLICATION ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF.
I have the right to make a request to Liberty, upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the recipients of any reports on me which Liberty has previously furnished within the two-year period preceding my request I hereby consent to your obtaining the above information from Liberty, and I agree that such information, which Liberty obtains, and my employment history with you if I am hired, will be supplied by Liberty to other companies that subscribed to Liberty. I hereby authorize procurement of consumer report(s). If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my employment (or contract) period.
I am employed in, seeking employment in, or reside in Minnesota or Oklahoma, and by checking this box, indicate that I would like to receive a copy of any Consumer Report about me, if one is obtained by Requestor
I understand that if I am employed in, seeking employment in, or reside in California, by signing below, I acknowledge that I have received a NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. By checking this box, I indicate that I would like to receive a copy of any Investigative Consumer Report about me, if one is obtained by Requestor.
*All information in this application is true to the best of my knowledge. Submit By Email