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The document is an authorization form for an individual to disclose information to HireRight LLC for the purposes of a background check. It lists several sources that may release information, including law enforcement, schools, testing agencies, employers, the military and other individuals. It allows HireRight to obtain information about the individual's employment, education, motor vehicle history, criminal history, military service and professional credentials. The individual must provide their name, any other names used and signature to authorize the background check and release of information.

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130 views1 page

38 PDF

The document is an authorization form for an individual to disclose information to HireRight LLC for the purposes of a background check. It lists several sources that may release information, including law enforcement, schools, testing agencies, employers, the military and other individuals. It allows HireRight to obtain information about the individual's employment, education, motor vehicle history, criminal history, military service and professional credentials. The individual must provide their name, any other names used and signature to authorize the background check and release of information.

Uploaded by

jeffagadu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Authorization for Disclosure of Information

I understand that in connection with my background check being performed by HireRight, LLC
(“HireRight”), one or more of the following source(s) are requiring my hand written signature in order to
authorize the release of information to HireRight. Accordingly, I hereby authorize all of the following,
without limitation, to disclose information about me to HireRight and its agents in connection with its
preparation of background reports on me.
 Law enforcement agencies;
 Learning institutions (including public and private schools, colleges and universities);
 Testing agencies;
 Information service bureaus;
 Record/data repositories;
 Courts
 Motor vehicle records agencies;
 My past or present employers;
 The military; and
 Other individuals and sources with any information about or concerning me.

The information that can be disclosed to the consumer reporting agency and its agents includes, but is
not limited to, information concerning my employment and earnings history, education, motor vehicle
history, criminal history, military service, professional credentials and licenses.

Applicant Last Name _______________________ First _________________ Middle _____________

Other Names Used ___________________________________________________________

Applicant Signature ________________________________ Date

LRD 05Jan2017

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