Employment Credit Check Authorization

EMPLOYMENT CREDIT & CRIMINAL CHECK AUTHORIZATION I authorize Weiss & Mueller, Ltd., or any other 3rd party, to obtain any and all past employment records. I am also giving authorization to check other areas of my background including but not limited to: statewide criminal checks, Federal criminal checks, driving history, educational records, and drug/alcohol testing results. Also by signing this said form I have given authorization to Weiss & Mueller, Ltd. to run a personal credit report on myself. I agree to hold Weiss & Mueller, Ltd., its client and my past employers, harmless regarding any information that is obtained during the background & credit check. I am aware that this report is prepared under the guidelines of the Fair Credit Reporting Act (FCRA) and I am eligible to receive, upon written request, a copy of the report, if not hired. Applicant:The request for your date of birth is to be used in performing a credit & criminal check only, and is not used by the client in consideration of employment. If you have a signed authorization, type your initials here Signature on file
CLIENT INFORMATION
Date:
Last Name:
First Name:
Middle Name:
Maiden Name:
Address:
City:
State:
Zip Code:
Social Security Number:
Date of Birth:
Client & Location:
Email: