BACKGROUND CHECK PERMISSION

. This Background Check Permission Agreement (the "Agreement") is made and effective this [DATE],


BETWEEN: [PROSPECTIVE EMPLOYEE NAME] (the "Employee"), an individual with his main address at:



AND: [COMPANY NAME] (the "Company"), a corporation organized and existing under the laws of the [STATE/PROVINCE], with its head office located at:



In connection with my application to render services to the Company, I hereby agree as follows:


1. GENERAL CONSENT TO BACKGROUND INVESTIGATION

As a condition of Company's consideration of my application to render services, I give permission to company to investigate my personal and employment history. I understand that this background investigation will include, but not be limited to, verification of all information given by me to the Company.


2. CONSENT TO CONTACT PAST EMPLOYERS AND COMPANIES

I specifically give permission to Company to contact all of my prior employers and companies I have provided services to for references. I further give permission to all current or previous employers and/or managers or supervisors to discuss my relevant personal and employment history with Company, consent to the release of such information orally or in writing, and hereby release them from all liability and agree not to sue them for defamation or other claims based upon any statements they make to any representative of Company. I further waive all rights I may have under law to receive a copy of any written statement provided by any of my former employers or companies I have provided services to Company. I further agree to indemnify all past employers or companies I have provided services to for any liability they may incur because of their reliance upon this Agreement.


3. CONSENT TO CONTACT GOVERNMENT AGENCIES

I further give permission to the Company to receive a copy of any information obtained in the file of any federal, state, or local court, or governmental agency concerning or relating to me. I further consent to the release of such information and waive any right under law concerning notification of the request for a release of such information. In the event a law does not provide for Company to have access to information, I hereby delegate the Company as my agent for the receipt of information. I understand that the scope of this investigation will be limited as required by applicable law.


4. COOPERATION WITH INVESTIGATION

I agree to fully cooperate in Company's background investigation, and to sign any waivers or releases that may be necessary or desirable to obtain access to relevant information. In the event that any former employer or other company or federal, state, or local governmental agency will not release reference information or criminal history information directly to the Company, I agree to personally request such information to the extent permitted by law.


5. MISCELLANEOUS

This Agreement represents the entire understanding and agreement relating to its subject matter. Company shall be entitled fully to rely on this Agreement. I understand that I have no guarantee of being hired to provide services to the Company and that the Company may determine not to engage me for any lawful reason.


COMPANY APPLICANT


Authorized Signature Authorized Signature
Print Name and Title Print Name and Title


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BACKGROUND CHECK PERMISSION