Consent To Criminal Background Check

[     ]   I hereby consent to a criminal background check and authorize the release of any information to [company name here]. I hereby release the company, its divisions, affiliates, and anyone acting on their behalf from any and all claims or liabilities of any nature arising from or related to the preparation and disclosure of the information contained in the criminal background report.

[     ]  I do not consent to a criminal background check.

_______________________________________________________________________ Name (please print)

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