Internship Application
PLEASE READ CAREFULLY
APPLICANT/PROMOTED EMPLOYEE/VOLUNTEER/INTERN AUTHORIZATION AND CONSENT FOR INQUIRY, BACKGROUND AND OTHER CHECKS
1) In order to be considered for employment, promotion, volunteer or intern services, you authorize Employers Reference Source, Baby Bloom New Born Care’s vendor, to make inquiries, including but not limited to, your education, professional licensing or training, criminal history, driving history, employment and volunteer history (including reasons for separation), your personal character, abilities, work habits, mode of living, residency, immigration status (for employment purposes), general reputation, performance, experience and other qualities that the Company believes are pertinent to our decision to employ, promote or retain you as a volunteer or intern. If allowed by law, based on the applicable position (e.g., positions that handle company funds), Employers Reference Source may check your consumer credit history.
2) In compliance with the Fair Credit Reporting Act, you are entitled to be informed if an offer of employment. is withheld because of credit information obtained by Employers Reference Source and, in that event, the Company will provide a copy of the report the Company receives and the FTC notice, “A Summary of Your Rights Under the Fair Credit Reporting Act.” For your records, a copy of this completed notice that a consumer credit report may be obtained for employment purposes, will be provided. Please retain it for your records.
3) Complete and sign this Authorization, where you are expressly stating, without reservation, any organization or person, including but not limited to, employers, law enforcement agencies, courts, state and federal government agencies, educational and other institutions and private information bureaus or repositories, to provide Employers Reference Source any or all of the above listed or requested information. Further, you are authorizing Employers Reference Source to provide the Company with this information or a summary of the information.
4) This Authorization releases the Company and Employers Reference Source (including its employees and officers) from any and all liability of any kind from the investigation and disclosure of the requested information, even if the information provided to Employers Reference Source is inaccurate or incomplete. Further, you release and discharge from all liability any companies, agencies, officials, officers, employees and other persons, who, in good faith, provide to Employers Reference Source the above requested information, in order to successfully complete a background investigation for the Company.
5) By signing above, you represent you understand the terms and scope of this Authorization and sign it voluntarily, and that you state the providing of a copy of this Authorization to obtain the requested information is as valid as the original.
This Authorization will expire if my application or promotion is declined or withdrawn by Company or me. Otherwise it does not expire. I may withdraw this Authorization by providing the Company with a written, signed and dated withdrawal request. The failure to sign or the withdrawal of this Authorization before an investigation is completed, as determined by the Company, will result in the declining of me application (for employment, volunteer or intern services) or withdrawal of my promotion.
*Date of Birth and Year of Graduation are being requested only for purposes of identification in obtaining accurate retrieval of records and information by Employers Reference Source and it will not be used for discriminatory or unlawful purposes.