In connection with my application for employment, I understand that an investigative consumer report will be conducted which may include information as to my work habits, performance, experience, education, credentials, references, driving record and criminal history. By signing below, I voluntarily and knowingly authorize Head Start, Inc. and/or its agents to verify any aspects of the information contained in my employment application or through public and private sources including federal, state, or local law enforcement agencies. I understand that any misrepresentation or any material omission on this application will result in my being eliminated from consideration for employment now and in the future. I further understand that, if accepted for employment, any misrepresentation or material omission which becomes known to Head Start, Inc. will result in immediate termination of my employment.
I, the undersigned Applicant, hereby authorize any private or public sources, including any federal, state or local law enforcement agency, having information concerning me, either public record or otherwise to release such information to Head Start, Inc and/or its agents. Further, I authorize any former employer, person, firm, corporation, school or government agency to release any and all information concerning my employment, to Head Start, Inc. and/or its agents.
I voluntarily and knowingly, fully release and discharge, absolve, indemnify and hold harmless, Head Start, Inc. and/or its agents, any former employer, person, firm, corporation, school or government agency from any and all liability or damages arising from the disclosure or release of any such information.
If hired, I understand this authorization shall remain on file and shall serve as an ongoing authorization for Head Start Inc. and/or its agents to procure a consumer report at any time during my employment period. I understand that I must provide my date of birth to adequately complete said background investigation, and acknowledge that my date of birth will not affect any hiring decisions.