
[]  There are two versions of the Background Research
Release provided here - long and short.  Use which ever best
meets your needs.

                 Background Research Release

Please read this section carefully and acknowledge your
understanding by signing your name in the space below.

I certify that all of the statements made by me on this
application for employment are true, correct, and complete
to the best of my knowledge.

1. Consent To Conduct Background Investigation
As a condition of and in consideration for [Company]'s
consideration of this application, 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 on this application, as well as interviews with
past employers. I further give permission to [Company] to
conduct this investigation and to discuss the results of
this investigation in connection with my application for
employment.

2. Consent To  Contact Past Employers
I give permission to [Company] to contact all employers
listed in this application [except those specifically
excluded] 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 state
law to receive a copy of any written statement provided by
any of my former employers to [Company]. I further agree to
indemnify all past employers for any liability they may
incur because of their reliance upon this release.

3. Consent To Contact Government Agencies
I give permission to any agent, attorney or representative
of [Company] to receive a copy of any information obtained
in the file of any federal, state or local court,
governmental agency, law enforcement agency or investigator
concerning or relating to me. I further consent to the
release of such information and waive any right under state
law concerning notification of the request for a release of
such information. In the event a state law does not provide
for prospective employers to have access to information, I
hereby delegate [Company] as my agent for receipt of
information. I understand that the scope of this
investigation will be limited to criminal and/or civil
records that relate to my honesty, integrity and/or
abilities.

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 to obtain access to relevant information. In
the event that any former employer or federal, state or
local governmental agency will not release reference
information or criminal history information directly to the
employer, I agree to personally request such information to
the extent permitted by law.

[]  Note: Some states prohibit employers from asking
applicants to request their criminal records. Check with
your state authorities and competent legal counsel prior to
making this request.

5. Falsification Statement
I understand that any falsification or willful omission of
fact made in this application or in connection with any
background investigation may be sufficient grounds for
rejection of this application, or, if discovered after an
offer of employment, for immediate dismissal.

6. Employment "At Will"
In consideration of my employment, I agree to conform to the
rules and regulations of [Company], and my employment and
compensation is "at will" in that they can be terminated
with or without cause, and with or without notice, at any
time, at the option of either [Company] or myself, except as
otherwise provided by law. I understand that no manager or
representative of [Company], other than the President of
[Company], has authority to enter into any agreement for
employment for any specified period of time or to make any
agreement or contract to the foregoing, and that any
promises to the contrary will only be relied upon by me if
they are in writing and signed by the President of
[Company].

______________________        __________
Applicant's Signature         Date

[]  Portions of this application are reprinted with
permission from a 1988 special report, Thieves at work: An
Employer's Guide to Combating Workplace Dishonesty (BSP 98),
published by The Bureau of National Affairs, Inc.

============================================================

                 Background Research Release

[]  If you consider using the services of one of the many
outside credit investigative reporting agencies, you have to
comply with the Fair Credit Reporting Act.  The most
important regulation under that act is that you provide the
applicant with written notification that you might obtain a
report on his/her background from either an outside agency,
or by your own subscription to such direct data base
services. However, a number of states have passed their own
versions of the Federal Act with more restrictions on the
notification. Hence, we suggest that instead of just
notification, you obtain written authorization from the job
applicant. This is already the law in New York and a few
other states.

[]  The authorization should not be in smaller print than
the rest of the application; it should be clear and
readable. We suggest that it be dated and witnessed by a
member of the employer's staff.

[]  Below is a sample authorization that also combines a
general release for prior employers, schools, military
authorities and governmental agencies to release information
to third parties.

[]  Even if you have no plans to use an outside agency, this
form is good to have in case you have to use an agency or
elect to do so in the future. Copies of the signed form
should be included with your written request for
information.

Authorization and General Release

The undersigned [Name of Applicant] in connection with this
application, authorizes all corporations, companies, credit
agencies, educational institutions, persons, law enforcement
agencies, military services and former employers to release
information they may have about me to [Company] or its
agents and releases them from any liability or
responsibility from doing so.  Further, I authorize the
procurement of an investigative consumer report and
understand that such a report may contain information about
my background, character and personal reputation. I
understand that this notice will also apply to any future
update reports that may be requested.


_____________________
Applicant's Signature

_____________________________
[x] [Witness's Name], Witness

_______
Date
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