RELEASE AUTHORIZATION

I. In connection with my application for employment, I understand that an investigative consumer report may be requested that will include information as to my character, work habits, performance, and experience, along with reasons for termination of past employment. I understand that as directed by company policy and consistent with the job described, you may be requesting information from public and private sources about my: workers' compensation injuries, driving record, criminal record, education, credit, and previous employment.


II. Medical and workers' compensation information will only be requested in compliance with the Federal Americans with Disabilities Act (ADA) and/or any other applicable state laws. According to the Fair Credit Reporting Act, I am entitled to know if employment is denied because of information obtained by my prospective employer from a consumer reporting agency. If so, I will be notified and be given the name of the agency or the source of the information.


III. I acknowledge that a telephonic facsimile (FAX) or photographic copy shall be as valid as the original. I release all persons and agencies from any liabilities or damages for having furnished such information in good faith. The requested information may be obtained at any time during the application process or during my employment with the company.


IV. Minnesota applicants only. If you want a copy of the report(s) ordered, check this
space.____ The report(s) will be sent by the reporting agency to you at the address below.


V. I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer or insurance company contacted to furnish the information described in Section I.

Today's Date______________      Signature____________________________________

Please print your full name___________________________________________________

The following information is required by law enforcement agencies and other entities for positive identification purposes when checking records. It is confidential and will not be used for any other purposes.

Please print other last names you have used ____________________________________

_____________________________________________________________________

Home Address__________________________________________________________

City____________________________State______________ZIP_________________

Social Security Number____________________________Date of Birth______________

Drivers License Number___________________________State Issuing DL____________