NOTIFICATION AND AUTHORIZATION FOR RELEASE OF INFORMATION AND CONSUMER REPORTS

This authorization, consent and release form is to allow Investigative Resource Group, (IRG), a division of Tumbling Creek, LLC and/or its agents to obtain background information and/or an investigative report in connection with my application for employment, continued employment, or tenancy. These reports might include, but are not limited to, searches of educational institutions attended, financial or credit agencies, records of previous employment including: work history, records from the U.S. Veteran’s Administration; criminal history information on file in local, state or federal agencies; worker’s compensation records; and motor vehicle records. I, by affixing my signature hereto acknowledge that these searches will be used to determine my employment and/or continued employment. I agree that a fax or photocopy of this authorization bearing my signature will be accepted with the same authority as the original. In addition, I release and discharge IRG and their agents, employees, successors, assigns and associates, to the extent permitted by law, from any claims, damages, losses, liabilities, costs, expenses, or any other charge or complaint filed with any agency or court arising from retrieving and reporting this information. I understand that this release will apply to any future updated reports that may be requested by my employer. In accordance with the Fair Credit Reporting Act, 15 U.S.C., et seq. I am entitled to receive, upon written request to Investigative Resource Group, Post Office Box 747 Harrison, TN 37341, additional information regarding the nature and scope of this background check, as well as receive a written summary of my rights under the Fair Credit Reporting Act. I certify that the information below is complete and true. I have read this release, consent to and understand its terms, realize it’s significance, and sign it voluntarily. By pressing “Submit” below, I attach my digital signature hereto and agree that the action of pressing “Submit” has the same significance as signing this document with ink.

Name

First Name

Last Name

Middle Name

Please provide your Middle Name.

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth

Social Security Number

Driver License State

Please enter the state that issued your Driver License.

Driver License Number

Please provide your Driver License Number and State.

Other Names Used

Please provide all other names that you have used.

Places I have lived

Please list all cities and states you have lived in.

By pressing "Submit", I hereby attach my electronic signature, authorizing Investigative Resource Group to perform an extensive background investigation on me. I agree that the information I have provided is true and correct and providing false information could disqualify me from the employment I am seeking. I also accept the terms and conditions contained herein. I further authorize IRG to disseminate the information obtained to the entity listed below .

Please enter the name of the company that you have applied with and who we may send your information to

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