Please read carefully: The information provided on this Authorization is true and correct to the best of my knowledge. I understand that failure to reveal any prior addresses in the past five years and/or the giving of false or misleading information on my application or in an employment interview may result in the refusal of or separation from employment.

I authorize the above company and its representatives to make an independent investigation of my background, references, character, past employment, education, criminal records, and for driving positions, motor vehicle information, as required by Section 391.23 of the Federal Motor Carrier Safety Regulations, maintained by public and private organizations.

I release the above company and/or its representatives from any and all liability, claims or lawsuits in regard to the information obtained from any or all references sources used in verification of my background. I also acknowledge that the above company may be requested to submit certain information with the above company to provide such information and release the above company and its representatives from any liability from submitting such information.

I request and authorize SL STAFFING EMPLOYMENT AGENCY to withhold the below fee(s) for my Background Check from my payroll check. Fee: $20.00