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| Please print this form out, sign it and fax it to us. Also send a copy of your Social Security and Drivers Licenses. 703.437.8043 or 13012 Elm Tree Court Herndon Virginia 20171. By signing this form a prospective consultant or independent contractor grants permission to perform background checks prior to using your services. In connection with my application for employment with NanniNanny, LLC I hereby agree as follows: 1. General Consent to Background Investigation As a condition of NanniNanny, LLC consideration of my employment application, I give permission to NanniNanny, LLC to investigate my personal and employment history. I understand that this background investigation will include, but not be limited to, verification of all information on my employment application. 2. Consent to Contact Past Employers I specifically give permission to NanniNanny,LLC to contact all of my prior employers for references. I further give permission to all current or previous employers and/or managers or supervisors to discuss my relevant personal and employment history. Consent to the release of such information orally or in writing, and hereby release them from all liability and agree not to sue them for defamation or other claims based upon any statements they make to any representative of NanniNanny,LLC. I further waive all rights I may have under law to receive a copy of any written statement provided by any of my former employers to NanniNanny,LLC. I further agree to indemnify all past employers for any liability they may incur because of their reliance upon this Agreement 3. Consent to Contact Government Agencies I further give permission to the NanniNanny,LLC to receive a copy of any information obtained in the file of any federal, state, or local court, or governmental agency concerning or relating to me. I further consent to the release of such information and waive any right under law concerning notification of the request for a release of such information. In the event a law does not provide for prospective employers to have access to information, I hereby delegate NanniNanny,LLC as my agent for the receipt of information. I understand that the scope of this investigation will be limited as required by applicable law. 4. Cooperation with Investigation I agree to fully cooperate in NanniNanny,LLC background investigation, and to sign any waivers or releases that may be necessary or desirable to obtain access to relevant information. In the event that any former employer or federal, state, or local governmental agency will not release reference information or criminal history information directly to the employer, I agree to personally request such information to the extent permitted by law. 5. Miscellaneous This Agreement represents the entire understanding and agreement relating to its subject matter. NanniNanny,LLC shall be entitled fully to rely on this Agreement. I understand that I have no guarantee of employment and that the NanniNanny, LLC may determine not to hire me for any lawful reason. I hereby authorize all corporations, companies, credit agencies, schools, government agencies, persons, military services and former employers to release information they may have about me to NanniNanny, LLC or its agents and employees, and release all persons or companies from any liability or responsibility from doing so. Further, I authorized the procurement of a consumer report and understand that such a report may contain information about my background, character, and personal reputation. I understand that this notice will also apply to any future update reports that may be requested. Applicant�s Signature ____________________________________________________________________ Applicant�s Printed Name ____________________________________________________________________ Date ____________________________________________________________________ Copyright NanniNanny, LLC 2002 |
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