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Employee Release Authorization

This document is an employee release authorization form. It authorizes Resource Staffing to conduct a background check on the applicant, including criminal, credit, and employment history records. It allows Resource Staffing to contact previous employers and educational institutions for reference checks. The applicant agrees to hold harmless all parties involved in the background check process. The applicant also authorizes Resource Staffing to provide the results of the background check to client companies.

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Steven Andrew
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69 views4 pages

Employee Release Authorization

This document is an employee release authorization form. It authorizes Resource Staffing to conduct a background check on the applicant, including criminal, credit, and employment history records. It allows Resource Staffing to contact previous employers and educational institutions for reference checks. The applicant agrees to hold harmless all parties involved in the background check process. The applicant also authorizes Resource Staffing to provide the results of the background check to client companies.

Uploaded by

Steven Andrew
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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EMPLOYEE RELEASE AUTHORIZATION

(Please read and sign this form in the space provided below. Your written authorization is necessary for completion of the
application process.)

In consideration of and connection with my application for employment (including contract for services,
if applicable) and as a consideration of continuing employment, I understand that an investigation
background inquiry will be performed on myself, including, but not limited to, consumer credit history,
criminal record history, worker compensation claim history, civil records history, driving record history,
employment history and other such reports that may exhibit information on my character, work habits,
performance, education and experience, along with reasons for termination of employment form
previous employers, where such information exists. Information will be researched and reported in
accordance with the Fair Credit Reporting Act.

I
Nipuna Indula Wanninayake , hereby authorize Resource Staffing to investigate my
background and qualifications for purposes of evaluating whether I am qualified for the position for
which I am applying. I understand that Resource Staffing may utilize an outside firm or firms to assist it
in checking such information, and I specifically authorize such an investigation by information services
and outside entities of the company’s choice. I also understand that I may withhold my permission and
that in such a case, no investigation will be done, and my application for employment will not be
processed further. Additionally, I hereby authorize, without reservation, Resource Staffing and the
directors, officers, employees, and agents of the foregoing, and any party or agency contracted by
Resource Staffing and their directors, officers, employees, and agents, as a condition precedent to
employment or as a condition of continuing employment, to contact any of my previous employers or to
contact schools, companies, credit bureaus, law enforcement agencies, government agencies, persons
and educational institutions to supply any information concerning my background and to furnish the
above listed information and to release and hold harmless all parties involved from any liability and
responsibility for doing so. I further agree to hold harmless all parties involved for any errors and/or
omissions with regard to information reported. I understand that any errors and/or omissions will be
investigated thoroughly until resolved. This authorization and consent shall be valid in original,
scanned, fax or copy form. I believe to the best of my knowledge that all the information I have
provided is accurate, true and correct and that I fully understand the terms of this release.

I further authorize Resource Staffing and or their authorized agent and representatives to provide the
results of my background investigation and/or drug test results to this company and its clientele.

06/24/2021
Applicant Signature Date
In order that we may perform the necessary checks, please complete the fields below

Company: Resource Staffing

Wanninayake Nipuna Indula


Last Name First Name Middle Name

indula9106@gmail.com 8162140985
Email Address Phone Number

N/A N/A
Maiden (or Other) Name Years (From-To)

N/A N/A
Maiden (or Other) Name Years (From-To)

43891673 Texas 06/20/2022


Driver’s License # State Expiration Date

06/20/1991 140-61-2574
Date of Birth Social Security Number

13035 Windfern Rd, APT# 219 Houston


Current Address City

TX 77064 2
State Zip Code Years at Address
Previous Addresses (last 7 years): Include street name, city, state, and zip code

7710 Chatham Springs Rd, Cypress, TX 1


Address Years of Occupancy

6 Edgewood Forest Ct, Spring, TX 1


Address Years of Occupancy

226 S West St, Stillwater, OK 3


Address Years of Occupancy

Address Years of Occupancy

Address Years of Occupancy

Address Years of Occupancy

Address Years of Occupancy


BACKGROUND INFORMATION

STATEMENT ON CRIMINAL BACKGROUNDS

Resource Staffing conducts criminal background investigations on all applicants considered for
employment with our firm. A conviction record will not necessarily bar employment. Factors such as
date of offense, seriousness and nature of the violation, relationship to the position for which you are
applying and rehabilitation efforts will be taken into account.

Please answer the question below

Have you ever been convicted of a crime, pleaded guilty to one, received deferred adjudication, or

have a case that is active?

Yes No ✔

If yes, please describe below.

INCIDENT (s)

CITY/STATE (s):

CHARGE (s):

In submitting this supplement to the application for employment, I authorize investigation of all information provided above,
and it is understood and agreed that any misrepresentation (including omission of information) by me will be sufficient
cause for cancellation of the application process and/or separation from Resource Staffing service if I am or have been
employed.

Signature of Applicant Date: 06/24/2021

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