I have carefully read and understand this Disclosure and Authorization form and the attached summary of rights
under the Fair Credit Reporting Act. By my signature below, I consent to preparation of background reports by a
consumer reporting agency such as HireRight, Inc (HireRight), and to the release of such background reports to the
Company and its designated representatives and agents, for the purpose of assisting the Company in making a
determination as to my eligibility for employment (including independent contractor assignments as applicable),
promotion, retention or for other lawful employment purposes. I understand that if the Company hires me or
contracts for my services, my consent will apply, and the Company may, as allowed by law, obtain additional
background reports pertaining to me, without asking for my authorization again, throughout my employment or
contract period form HireRight and/or other consumer reporting agencies.
I understand the information contained in my employment or contractor application, or otherwise disclosed by me
before or during my employment or contract assignment, if any, may be used for the purpose of obtaining and
evaluating background reports on me. I also understand that nothing herein shall be construed as an offer of
employment or contract services.
I hereby authorize all of the following, without limitation, to disclose information about me to the consumer reporting
agency and its agents: law enforcement and all other federal, state and local agencies, learning institutions
(including public and private school, colleges, and universities), testing agencies, information services bureaus,
credit bureaus, record/data repositories, courts (federal, state and local), motor vehicle record agencies, my past or
present employers, the military, and all other individuals and sources with any information about or concerning me.
The information that can be disclosed to the consumer reporting agency and its agents includes, but is not limited
to, information concerning my employment and earnings history, education, credit history, motor vehicle history,
criminal history, military service, professional credentials and licenses.
By my signature below, i also certify the information I provided on and in connection with this form is true, accurate
and complete. I agree that this form in original, faxed, photocopied or electronic (including electronically signed)
form, will be valid for any background reports that may be requested by or on behalf of the Company.