I, in connection with my consideration for approval for Dementia Society Training with Simplicity Asset-Based LTC, hereby authorize Simplicity Asset-Based LTC (“Company”) and screeningONE, Inc. to perform a pre-employment background screening check (including future screenings for retention, reassignment or promotion, if applicable, and unless revoked by Applicant in writing). I understand and agree to the following:
A background check is not only for the benefit of Company as a sound business practice but also for the benefit of all employees. It is no reflection on an applicant. I have read, understand and signed the separate Disclosure concerning my rights.
All reports are confidential and provided to Company for employment decisions only. Consumer credit information including credit reports is obtained in strict compliance with the Fair Credit Reporting Act, the Americans With Disabilities Act (ADA), anti-discrimination and privacy laws and all other applicable federal and state laws.
I may review or obtain a copy of my report as provided by law. screeningONE may be contacted by writing to screeningONE, Inc., 1860 N. Avendia Republica de Cuba, Tampa, FL 33605.
I authorize and release people, companies, references, current and former employers, schools, credit bureaus, municipal, county, state and federal agencies and courts, and agencies that provide motor vehicle records, to provide all information that is requested to Company or screeningONE.
I further release all of the above, including Company and screeningONE, to the full extent permitted by law, from any liability or claims arising from retrieving and reporting information concerning me.
I agree that a copy or fax of this document shall be as valid as the original.
COURTS AND OTHER ENTITIES REQUIRE THE FOLLOWING INFORMATION FOR INDENTIFICATION WHEN CHECKING PUBLIC RECORDS. IT IS CONFIDENTIAL AND IS USED FOR INDENTIFICATION ONLY. YEAR OF BIRTH ENSURES ACCURACY AND AVOIDS DELAY.
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