Applicant Release Form
PLEASE PRINT CLEARLY AND COMPLETE ALL SECTIONS
Date:
Name:
Address:
Phones: (Home,Cell,Work)
SSN: ______DOB ______
Driver License # & State of Issue:______
Applicant Release Agreement
In connection with any application made by me, I understand that you may be requesting information from various Federal, State, and other agencies which maintain records concerning past activities relating to my credit, criminal, driving, civil, and other records and experiences, including claims involving me in the files of insurance companies, if any. These reports may also include information on education, experience, work habits, and performance, along with reasons for termination of employment from previous employers, if any. I also agree, that should I become an employee, my employer has the right to perform the above searches at any time during my employment.
Without reservation, I authorize any party or agency contacted to furnish the above-mentioned information and release all parties involved from any liability and/or responsibility for doing so. I hereby consent to the potential employer, their agent, designee or other approved and licensed assign, to obtain any and all pertinent and or relative information. This authorization and consent shall be submitted in an original, fax, or copy form.
I have the right to make a request upon proper identification and payment of any authorized fees, the information in its files on me at the time of my request. We do hereby agree to provide the requested information in accordance with the Fair Credit Reporting Act and submit a written report via U.S. mail or fax.
Signature: X______Date:______
Keep a copy of all applicant release forms for your records for a minimum of 2 years
Warranty/Disclaimer/Limitation of Liability
CPS, Inc. warrants that its services are of highly professional quality, consistent with known industry standards at the time of execution of this document. Any remedy for breach of this warranty is that in the sole reasonable judgment of CPS, Inc. it does not conform to such standards. CPS, Inc. expressly disclaims all other warranties, expressed or implied, statutory or otherwise, including, without limitation, any implied warranties of merchantability or fitness for a particular purpose, warranties of title or non-infringement of third party rights, and warranties as to accuracy, completeness or adequacy of information. CPS, Inc. uses outside sources of information that it believes to be reliable; however, no warranties whatsoever are made with respect to the accuracy, completeness, content or timeliness of such information and CPS, Inc. does not undertake to advise any client of any change or update in the information. CPS, Inc., its directors, officers, employees and agents shall not be responsible or liable to Client, third party or any other entity for any direct, compensatory, indirect, incidental, consequential, or special losses or damages that result from or relate to the use of CPS, Inc. services or work product, including, without limitation, the viewing, distributing or copying of information, or reliance on the content or data provided to Client whether or not CPS, Inc. has been advised of the possibility of such damages.