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Release Authorization

PLEASE READ AND COMPLETE

I. In connection with my application for employment, I hereby authorize to request any present or former employer, school, police department, financial institution or other persons having personal knowledge about me to furnish the consumer reporting agency or bearer with any and all information as to my character, general reputation, personal characteristics, and mode of living in connection with my application for employment. This information may reveal my work habits, including oral assessments of my job performance, experiences and abilities, along with reasons for termination of past employment.

II. I further authorize to obtain information and records that includes, but is not limited to, credit history, criminal record, civil matters, driving record, previous employment, education verification, and professional license verification. A consumer report containing injury and illness records and medical information may be obtained after a tentative offer of employment has been made. Information is being procured from:

Selection Management - P.O. Box 130369 - The Woodlands, TX 77393 - Tel. 281.419.2500

III. In exchange for the employer's consideration of my employment application, I agree not to file or pursue any complaints, claims or legal actions of any kind against Selection Management for providing the aforementioned information. I also agree not to file or pursue any complaints, claims or legal actions against or any of its employees, representatives, or agents arising out of or in any way related to conducting a reference check or background investigation.

IV. I am consenting that a photocopy of this authorization be accepted with the same authority as the original, and I specifically waive any written notice from any present or former employer who may provide information based on this authorized request. I understand this authorization is to be part of the written employment application that I sign.

V. I have been given a stand-alone consumer notification that a report will be requested and used for the purpose of evaluating me for employment, promotion, reassignment or retention as an employee. If hired, this authorization shall remain on file and shall serve as an ongoing authorization to procure consumer reports or investigative consumer reports at any time during my employment period.

VI. I am entitled to receive a free copy of my consumer report before any adverse decision of possible employment is made because of information obtained within my report.

The following information is required by law enforcement agencies and other organizations for positive identification purposes when checking public records. It is confidential and will not be used for any other purposes.

Full Name
Other Names You Have Used

Home Address
City/County/State/Zip
Drivers License Number	State
Sex	Male Female
Race	Asian Black Hispanic White Other
Date of Birth (mm/dd/yyyy)
Social Security Number
Date

Signature	________________________________________

If required, Notarize* here

* When using an embossed seal, please shade with pencil before FAXing.

Subscribed and sworn to me:	________________________________________
Notary Name:	________________________________________
My commission expires:	____________________

Please print this form, sign 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