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THIS PAGE CONTAINS SENSITIVE INFORMATION, KEEP ONLY IN SECURE FILES, SEPARATELY FROM PERSONNEL RECORDS!
 
I. In connection with my application for employment, I understand that a thorough background check may be requested, involving information as to my character, work habits, performance, and experience, along with reasons for termination of past employment. I further understand information may be requested from public and private sources about my: worker's compensation injuries, driving record, criminal record, education, previous employment, and salary history.
 
II. Medical and workers' compensation information will only be requested in compliance with the Federal Americans with Disabilities Act (ADA) and/or any other applicable state laws.
 
III. I acknowledge that a telephonic facsimile (FAX) or photographic copy shall be as valid as the original. This release is valid for most federal, state and county agencies including the Minnesota Department of Labor.
 
IV. Oklahoma and Minnesota applicants only. If you want a copy of the report(s) ordered, check this box . The report(s) will be sent by the reporting agency to you at the address below.
 
V. California applicants only. If you would like a copy of the report(s) ordered, check this box . A copy of your credit report may be obtained during the course of this investigation. If your credit information is obtained and you would like a copy of that report, check this box . All information will be sent by the reporting agency to you at the address listed on this form.
 
VI. I hereby authorize without reservation, any law enforcement agency, institution, information service bureau, school, employer, reference or insurance company contacted by GPG to furnish the information described in Section I.
 
VII. New York applicants. I understand that Griffin Personnel Group may be requested to provide a consumer report to my potential employer and that I may inspect or request a copy of that report at the address shown on this form.
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Griffin Personnel Group, Inc. • 2299 Technology Drive, Suite 200 • O’Fallon, MO 63368 • Office: (636) 561-4950 • Fax: (636) 561-8813