The information contained in this application is correct to the best of my knowledge. I hereby authorize CCLC to conduct a review of my background causing an investigative report to be generated for employment and/or volunteer purposes.
I understand that the scope of the investigative report may include, but is not limited to the following area; Verification of social security number, current and previous residences, any criminal justice agency in any or all federal, state, and county jurisdictions; driving record, birth records and any other public records.
I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information (verbal or written) pertaining to me, to CCLC. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources.
CCLC shall maintain all information received from this authorization in a confidential manner in order to protect the applicant's personal information, including, but not limited to, addresses, social security numbers, and dates of birth.
If anything will show up on your record upon CCLC executing this records search, please provide a brief explanation below:
