Junior High Volunteer Cover Sheet (Page 3 of 3) in pdf

TULSA PUBLIC SCHOOLS

BACKGROUND CHECK AUTHORIZATION AND RELEASE

In connection with my employment/volunteerism or application for employment (including contract

for services and volunteer work), an investigative consumer report and consumer reports, which

may contain public record information, may be requested from AMERICANCHECKED, INC.

These reports may include the following types of information: names and dates of previous

employers, reason for termination of employment, work experience, accidents, academic history,

professional credentials, drugs/alcohol use, information relating to your character, general

reputation, personal characteristics, mode of living, educational background, or any other

information about you which may reflect upon your potential for employment gathered from any

individual, organization, entity, agency, or other source which may have knowledge concerning

any such items of information. Such reports may contain public record information concerning

your driving record, workers’ compensation claims, credit, bankruptcy proceedings, criminal

records, etc, from federal, state and other agencies which maintain such records.

I authorize TULSA PUBLIC SCHOOLS, or its agent, AMERICANCHECKED, INC. or other entity,

prepare

consumer

report

investigative

consumer

report

about

for

employment/Volunteer-related purposes. I have been provided a copy of the summary of the

rights of the consumer pursuant to the Fair Credit Reporting Act (FCRA).

I hereby fully release and discharge AMERICANCHECKED, INC., their respective affiliates,

subsidiaries, directors, officers, employees, agents and attorneys thereof, and each of them, and

any individual, organization, entity, agency, or other source providing information to

AMERICANCHECKED, INC. from all claims and damages arising out of or relating to any

investigation of my background for employment/volunteer purposes. This release is valid for all

federal, state, county and local agencies, authorities, previous employers, military services and

educational institutions.

AMERICANCHECKED, INC. is authorized to disclose all information obtained to the requesting

entity for the purpose of making a determination as to my eligibility for employment/volunteerism,

promotion or any other lawful purpose. I agree that such information, and my employment history,

may be supplied to AMERICANCHECKED, INC. If hired or contracted, this authorization shall

remain on file and shall serve as ongoing authorization for the procurement of consumer reports at

any time during my employment/volunteerism or contract period.

By signing below, I certify that I have read and fully understand this release, that prior to signing I

was given an opportunity to ask questions and to have those questions answered to my

satisfaction, and that I executed this release voluntarily and with the knowledge that the

information being released could affect my being hired, my employment/volunteerism, or my

eligibility for promotion.

Signature of volunteer_______________________________________ Today’s Date ________________

Junior High Volunteer Cover Sheet Page 3