| 1) Print Out Form 2) Fill Out Information 3) Sign The Bottom 4) Fax To 888-894-2133 |
Release and Applicant Information Form
TR Information Services
Requestor Information:
Contact Person:
________________________
Company__________________________
Applicant/Subject
Information:
Name: ______________________________________________ Home Phone: ______________
Please Print All Requested
Information
Current Address:
______________________________ City: ____________ ST: _____ Zip:______
Sex: _____
Date of Birth: ___________________ SSN________________________
Drivers License
Number: ______________________________________
State: _______
I understand and agree that: The information
supplied, was submitted by myself, and all information is true and correct, to
the best of my knowledge. I understand that false or misleading information
given in my application and/or interview(s) will be considered as cause for
possible dismissal and/or discharge. I also understand that I am to abide by
all rules and regulations of the company.
The company has my authorization to thoroughly investigate
my work and personal history. I understand that the information supplied by
me, regarding my: Employment History, Education (including an authorization
to release transcripts), Credit History, Criminal History, Medical and Professional
Licensing, Motor Vehicle Record(s), Residence History, and References, will
be utilized as part of the processing procedures. A background check will
be conducted to verify the veracity of the information submitted and will
be utilized to develop information concerning my character, general reputation,
personal characteristics, and mode of living. I will hold no person liable
for giving or receiving information in this investigation. I hereby
authorize
TR Information Services an
agent of ___________________________________________________
(company name)
may be asked to make a thorough
check of my credit history, driving history, criminal history , past employment,
education, and activities. I release from liability all persons, companies,
and corporations supplying that information. I release and indemnify
____________________________ (company name) and TR
Information Services against any liability that might result from making such
background checks. A copy of this form is as valid as the original.
Applicant's Signature: X
_____________________________________ Date: __________