Authorization to Obtain Records and other Information for Employment Purposes
To the applicant: Read all information carefully before signing. Direct any questions to Human Resources.
I hereby authorize Alliance Home Care Agency to conduct an investigation into my background, which may consist of the following: employment history, education, DMV records, criminal background records, and other records as my be appropriate.
The facts set forth in my application for employment are true and complete. I understand that if employed, any false statement or omission of information on my application form may result in my termination. I further understand that this application is not intended to be a contract of employment, nor does this application serve as an obligation in any way to employ me or not to employ me.
I hereby fully waive any rights or claims that I have or may have against all current and/or former employers, and their agents, employees, and representative and damages that my directly or indirectly result from the use, disclosure or release of any information by any person or party, whether such information is favorable or unfavorable to me. I further waive any claim against you and any outside agency utilized by you as a result of any information which is obtained in this investigation.
*An applicant's date of birth is not used in our decision making process but obtained solely for reference checking purposes, inclusive of criminal background checks.
