Background And Criminal History Check Consent Form - Homestretch


Background and Criminal History
Check Consent Form
I, ____________________________________________________________________, am an applicant for
employment/volunteerism with Homestretch, Inc. and have been advised that as part of the application process,
the company conducts a criminal history background report that may include, but are not limited to,
employment and education verifications, personal references, personal interviews; my personal credit history;
and driving record. I do hereby consent to Homestretch the use of the information provided during the
application process in performing the background report. Homestretch has informed me that I have the right to
review and challenge any negative information that would adversely impact a decision to offer
employment/volunteerism. In addition, I have been informed that I will have a reasonable opportunity to clear
up any mistaken information reported within a reasonable time frame established within the sole discretion of
Homestretch, Inc. Under the Fair Credit Reporting Act, I have been advised that upon request I will be
provided the name, address telephone number of the reporting agency as well as the nature, substance and
source of all information.
I release Homestretch, Inc. and its agents and any person or entity, which provides information pursuant to this
authorization, from any and all liabilities, claims or law suits in regards to the information obtained from any
and all liabilities, claims or law suits in regards to the information obtained form any and all of the above
referenced sources used. The following is my true and complete legal name and all information is true and
correct to the best of my knowledge.
Personal Information
Applicant/Employee/Volunteer Name (Last, First,
Signature (handwritten)
Social Security
Date of Birth*
*Note: The above information is required for criminal History Checks only, and is in no manner used as qualifications for
employment, internship, or service as a volunteer. Homestretch abides by all applicable state and federal employment laws.
This information is kept separate from your personnel file.


00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal