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General Inquiry Release Consent Form

IN CONNECTION WITH NEGOTIATIONS FOR POTENTIAL BUSINESS AND/OR PERSONAL RELATIONSHIPS, WITH ,INCLUDING CONTRACT FOR SERVICES, INVESTMENTS, PARTNERSHIPS AND/OR PROMOTIONS, I UNDERSTAND THAT INVESTIGATIVE BACKGROUND INQUIRIES ARE TO BE MADE ON MYSELF INCLUDING CONSUMER, CRIMINAL, DRIVING, AND OTHER REPORTS. THESE REPORTS MAY INCLUDE INFORMATION AS TO MY CHARACTER, WORK HABITS, AND PERFORMANCE. FURTHER, I UNDERSTAND INFORMATION WILL BE REQUESTED FROM VARIOUS FEDERAL, STATE AND OTHER AGENCIES, WHICH MAINTAIN RECORDS CONCERNING MY PAST ACTIVITIES RELATING TO MY DRIVING, CREDIT, CRIMINAL, CIVIL AND OTHER EXPERIENCES AS WELL AS CLAIMS INVOLVING ME IN THE FILES OF INSURANCES COMPANIES.

I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY THE PROSPECTIVE BUSINESS OR ITS AGENT TO FURNISH THE ABOVE MENTIONED INFORMATION.

I HEREBY CONSENT TO YOUR OBTAINING THE ABOVE INFORMATION FROM SELECTION MANAGEMENT AND/OR ANY OF THEIR LICENSED AGENTS.

PRINT NAME (Last, First, MI):
CURRENT ADDRESS:
CITY/COUNTY/STATE/ZIP:
DRIVERS LICENSE NUMBER:	STATE:
DATE OF BIRTH:
SOCIAL SECURITY NO:
PREVIOUS ADDRESS:
CITY/COUNTY/STATE/ZIP:
OTHER NAME YOU MAY HAVE GONE BY:

SIGNATURE:	________________________________________

DATE:

WITNESS SIGNATURE:	________________________________________

Please print this form, sign and witness it and either FAX it to 281.419.2502 or mail it to:

Selection Management
P.O. Box 130369
The Woodlands, TX 77393-0369 USA
Voice: 281.419.2500, FAX: 281.419.2502