Applicant Authorization Consent For Release of Information

_____________ requires, as a condition of employment , and/or continued employment, that all applicants consent to and authorize a verification of the information submitted on their application or resume. Please read this statement carefully.

I, _____________ do hereby certify that the information provided by me for the purpose of employment is true and complete to the best of my knowledge. I understand that if I am employed any false statement will be considered as cause for possible dismissal.

The release and authorization acknowledge that BXB Express Freight Inc located at 6854 Lorel Ave Skokie, IL 60077 may now, or at any time while I am employed, conduct a verification of my education, employment history, social security, credit history, motor vehicle records, contact my personal references, and receive any criminal history record information pertaining to me which may be in the files of any Federal, State, or Local criminal justice agency in any state, and/or other information as deemed necessary to fulfill the job requirements. Also, if an offer of employment has been made, I authorize review of my worker's compensation claims history.

I authorize located at to disclose orally and in writing the results of the verification process to the designated authorized representative of BXB Express Freight Inc. The results will be used to determine employment eligibility under this company's employment policies.

I have read and understand this release and consent, and I authorize the background verifications. I authorize persons, schools, current and former employers, and other organizations and agencies to provide agents of my prospective employer with all information that may be requested, and I hereby release all of the persons and agencies providing such information from any and all claims and damages connected with their release of any requested information. I agree that any copy of this document is as valid as the original.

I do hereby agree to forever release and discharge BXB Express Freight Inc, and their associates to the full extent permitted by-law from any claims, damages, losses, liability, costs, and expenses, or any other charge or complaint filed with any agency arising from the retrieving and reporting of information. According to the Federal Fair Credit Reporting Act, I am entitled to know if employment was denied as a result of information obtained by my prospective employer, and to receive, upon written request, a disclosure of the pubic record information and of the nature and scope of the investigative report.