Employee/Applicant Authorization To Obtain Information

I hereby acknowledge that I have been notified by (hereafter, "Employer") that said Employer may obtain one or more Background Investigation Reports (also known as "consumer reports" or "investigative consumer reports") on me concerning my credit worthiness, credit standing, credit capacity, criminal history, character, general reputation, personal characteristics, educational background, licensure, status of professional credentials, training or educational background and history, and or mode of living. I understand that such reports may be obtained in connection with my application for employment and at any time during my employment with the Employer. Examples of such reports include criminal history reports, motor vehicle driving records, workman's compensation claims records, drug screening test reports, credit histories, records of my training and education, records of my involvement in civil litigation, records of my military service, and other records, and may include inquiries to neighbors, references I have provided, and other inquiries that may be considered useful by my Employer in evaluating my suitability for employment, continued employment, or promotion.

I hereby authorize Employer, their agent, Secure Systems Group, Ltd, and agents or representatives of Secure Systems Group, Ltd. to seek and obtain any and all information of the types described above as may be deemed necessary by my Employer in connection with my current application for employment or at any time in connection with my employment.. I authorize my current and past employers, police departments and other Government agencies, Credit or Financial Institutions, Educational Institutions, Medical Facilities, and others holding information about me, to furnish my employer and Secure Systems Group, Ltd. and its agents with any and all information of the above types in their possession for their use in evaluating my suitability for employment or promotion. I understand that my Employer and its agent, Secure Systems Group, Ltd. are not responsible for the accuracy of information provided by third parties, but have been advised that any adverse information developed through these inquiries will be discussed with me before my employer makes any final determination based on that information.

I understand that I can make a written request to my Employer for disclosure of the nature and scope of any investigation they request. I further understand that my Employer will advise me in writing if any report that is received contains derogatory or otherwise negative information about me, and understand that I will be provided with a complete copy of any report containing such information, along with a summary of my rights under the Fair Credit Reporting Act. I also understand that if my Employer intends to take any adverse action as a result of information contained in such reports, my Employer will notify me in writing, in advance of such action. I understand that any consumer reports or investigative consumer reports that Employer obtains will be strictly used for employment purposes, and will not be disseminated to any third party. I also understand that this, my consent, is a continuing consent that will remain valid until such time as I inform my Employer, in writing, that I wish to revoke this consent.

Applicant/Employee Data

Current Address:
Previous Addresses
     (Past 7 Years)

Current Employer:
Social Security Number:                                                                 Date of Birth:

Signature of Applicant or Employee Date