In connection with your employment or application for employment (including independent contractor assignments, if
applicable) and in accordance with pertinent laws, HireRight may obtain or assemble consumer reports and/or
investigative consumer reports (collectively, “Reports”) related to information concerning your: previous employment
(including employers, dates of employment, salary information, reasons for termination, etc.), academic history,
verification of references and verification of other information supplied by you, professional credentials, drug/alcohol
use in violation of law and/or company policy, driving record, accident history, workers’ compensation claims, credit
history, creditworthiness, credit capacity, bankruptcy filings, criminal history records and information about your
character, general reputation, personal characteristics and mode of living (collectively, “Information”). Information
may be obtained from government agencies, educational institutions, HireRight clients, personal references, personal
interviews and other Information sources (collectively, “Suppliers”).
Upon providing proper identification and subject to applicable legal requirements and restrictions, you have the right
to request the nature and substance of all Information in HireRight’s files pertaining to you, as well as information
including, but not limited to: (i) whether any Reports have been provided by HireRight to other parties; (ii)
identification of any Suppliers utilized by HireRight in compiling such Reports; and (iii) identification of any recipients
of Reports furnished by HireRight within certain statutorily-prescribed time periods preceding your request. HireRight
may be contacted by mail at P.O. Box 33181, Tulsa, Oklahoma, 74153, or by phone at (800) 381-0645.
If you are a Maine, Massachusetts, New York or Washington State applicant, employee or contractor, please also
refer to the additional state law notices attached herewith.
AUTHORIZATION FOR RELEASE OF INFORMATION
I hereby authorize HireRight to obtain Information and disclose Information to its customers (“Customers”), if
applicable, for the purpose of making a determination as to my eligibility for employment (including independent
contractor assignments), promotion, retention or other lawful purpose. If hired or contracted, I authorize HireRight and
HireRight Customers, if applicable, to retain this document on file to act as ongoing authorization for the procurement
and assembly of Reports at any time during my employment or contract period. As permitted by law, I fully release
HireRight and Suppliers from all claims of damages related to the investigation of my background and provision of
Information as set forth in this document. I agree that Information in HireRight’s possession and my employment
history with Customers if I am hired or contracted may be supplied by HireRight to other HireRight Customers for
legally permissible purposes.
By signing below, I certify that: (i) all information provided herein is complete and accurate; (ii) I have read and fully
understand this disclosure and authorization for release; (iii) prior to signing I was given an opportunity to ask
questions and to have those questions answered to my satisfaction; (iv) I execute this authorization voluntarily and
with the knowledge that the Information obtained pursuant to this authorization could affect my eligibility for
employment, independent contractor status, promotion, retention or other lawful purpose; (v) I understand I may
review this document with legal counsel prior to signing; (vi) I authorize HireRight and any person or entity contacted
by HireRight to furnish the above-mentioned Information; and (vii) facsimile or e-mail copies of this authorization are
as valid as an original.