Drug Test Authorization | Work Group USA

EMPLOYMENT BACKGROUND CHECK AUTORIZATION FORM

I understand that Work Group USA, LLC will utilize the services of a consumer reporting agency as part of the procedure for processing my application for employment. I also understand if my application for employment is granted, Work Group USA, LLC may obtain further information through subsequent investigations by a consumer reporting agency so as to update, renew or extend my employment.

I understand a consumer reporting agency’s investigation may obtaining information converting up to the last seven (7) years, regarding my credit background, references, character, past employment, work habits, education, general reputation, personal characteristics, mode of living, civil judgments, and liens, as well as any information about my criminal conviction background consistent with federal and state law.

I understand such information may be obtained by direct or indirect contact with former employees, schools, financial institution, landlords and public agencies or other persons who may have such knowledge.

I also understand that before I am denied employment based, in whole or part, on information obtained in the report, I will be provided a copy of the report and description in writing of my rights under the Fair Credit Reporting Act.

I understand if I disagree with the accuracy of any information in the report, I must notify Work Group USA, LLC within five (5) business days of my receipt of the report. If I notify Work Group USA, LLC within five (5) business days of the report that I am challenging information in the report, Work Group USA, LLC will not make a final decision on my employment status until after I have had a reasonable opportunity to address the information contained in the report.

I fully understand the purpose and content of this document and authorize background check verification, to the best of my knowledge, this information is correct and up to date. Any misrepresentation, omission, misleading or falsification of facts may be grounds for rejection of employment or discharge after employment.

I hereby consent to this investigation and authorize Work Group USA, LLC to procure a report on my background as stated above from a consumer reporting agency.

Name

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Social Security Number

Sex

Date Of Birth

Driver License Number

State Of Issuance

Expiration Date

Residence in the previous 10 Years. (Include City and State)

Your Signature

Date

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