AUTHORIZATION TO OBTAIN CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT

    I acknowledge receipt of the separate documents entitled DISCLOSURE REGARDING CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT, STATE LAW NOTICES, and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT. I further certify that I have read and understand these documents. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by the Company.

    I also agree that this authorization is not limited to the present. If hired or engaged to transact business with the Company, my authorization will continue to allow the Company to conduct future screenings for retention, promotion and reassignment, access to the Company’s premises or its customer’s premises, in relationship to
    business activities on behalf of the Company, unless revoked by me in writing or in the event of my termination.

    This document will also serve as my general release of information. To this end, I authorize without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, drug laboratory, employer, or insurance company to furnish any and all
    information requested by eVerifile, 855.383.7434, 5000 Corporate Ct., Ste 203, Holtsville, NY 11742, www.everifile.com , and/or the Company itself. I agree that a facsimile (“fax”), electronic, or photographic copy of this document shall be as valid as the original.

    I HEREBY CERTIFY THAT THIS FORM WAS COMPLETED BY ME; THAT THE INFORMATION PROVIDED IS TRUE AND
    CORRECT AS OF THE DATE NOTED. I also certify that I have carefully read and understood this authorization
    form.

    The below-requested information will be used for background screening purposes only.