Copyright Envision Corporation. 2002. All rights reserved.

Protected by the copyright laws of the United States & Canada and by nternational treaties. ! S
""E#A" A$% S!&C!"' P&()*!E% !( %S!&*U!E+ PU*"S)+ (,,E& ,(& SA"E+ "CE$SE (& SU*"CE$SE+ #-E (& %SC"(SE !( A$' (!)E&
PA&!'+ !)S P&(%UC! $ )A&% C(P' (& %#!A" ,(&.. A"" (,,E$%E&S /"" *E SUE% $ A C(U&! (, "A/.
BACKGROUND CHECK PERMISSION
!his *ac0gro1nd Chec0 Per2ission Agree2ent 3the 4Agree2ent45 is 2ade and effective this 6%A!E7+
BETWEEN: [PROSPECTIVE EMPLOYEE NAME] 3the 4E2ployee45+ an individ1al with his
2ain address at8
AND: [COMPANY NAME] 3the 4Co2pany45+ a corporation organi9ed and e:isting 1nder the laws of the
6S!A!E;P&(-$CE7+ with its head office located at8
n connection with 2y application to render services to the Co2pany+ hereby agree as follows8
1.GENERAL CONSENT TO BACKGROUND INVESTIGATION
As a condition of Co2pany<s consideration of 2y application to render services+ give per2ission to
co2pany to investigate 2y personal and e2ploy2ent history. 1nderstand that this bac0gro1nd
investigation will incl1de+ b1t not be li2ited to+ verification of all infor2ation given by 2e to the Co2pany.
2.CONSENT TO CONTACT PAST EMPLOYERS AND COMPANIES
specifically give per2ission to Co2pany to contact all of 2y prior e2ployers and co2panies have
provided services to for references. f1rther give per2ission to all c1rrent or previo1s e2ployers and;or
2anagers or s1pervisors to disc1ss 2y relevant personal and e2ploy2ent history with Co2pany+ consent
to the release of s1ch infor2ation orally or in writing+ and hereby release the2 fro2 all liability and agree
not to s1e the2 for defa2ation or other clai2s based 1pon any state2ents they 2a0e to any
representative of Co2pany. f1rther waive all rights 2ay have 1nder law to receive a copy of any written
state2ent provided by any of 2y for2er e2ployers or co2panies have provided services to Co2pany.
f1rther agree to inde2nify all past e2ployers or co2panies have provided services to for any liability
they 2ay inc1r beca1se of their reliance 1pon this Agree2ent.
*ac0gro1nd Chec0 Per2ission Page = of >

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Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United States & Canada and by nternational treaties. ! S
""E#A" A$% S!&C!"' P&()*!E% !( %S!&*U!E+ PU*"S)+ (,,E& ,(& SA"E+ "CE$SE (& SU*"CE$SE+ #-E (& %SC"(SE !( A$' (!)E&
PA&!'+ !)S P&(%UC! $ )A&% C(P' (& %#!A" ,(&.. A"" (,,E$%E&S /"" *E SUE% $ A C(U&! (, "A/.
3.CONSENT TO CONTACT GOVERNMENT AGENCIES
f1rther give per2ission to the Co2pany to receive a copy of any infor2ation obtained in the file of any
federal+ state+ or local co1rt+ or govern2ental agency concerning or relating to 2e. f1rther consent to the
release of s1ch infor2ation and waive any right 1nder law concerning notification of the re?1est for a
release of s1ch infor2ation. n the event a law does not provide for Co2pany to have access to
infor2ation+ hereby delegate the Co2pany as 2y agent for the receipt of infor2ation. 1nderstand that
the scope of this investigation will be li2ited as re?1ired by applicable law.
4.COOPERATION WITH INVESTIGATION
agree to f1lly cooperate in Co2pany<s bac0gro1nd investigation+ and to sign any waivers or releases
that 2ay be necessary or desirable to obtain access to relevant infor2ation. n the event that any for2er
e2ployer or other co2pany or federal+ state+ or local govern2ental agency will not release reference
infor2ation or cri2inal history infor2ation directly to the Co2pany+ agree to personally re?1est s1ch
infor2ation to the e:tent per2itted by law.
5.MISCELLANEOUS
!his Agree2ent represents the entire 1nderstanding and agree2ent relating to its s1b@ect 2atter.
Co2pany shall be entitled f1lly to rely on this Agree2ent. 1nderstand that have no g1arantee of being
hired to provide services to the Co2pany and that the Co2pany 2ay deter2ine not to engage 2e for any
lawf1l reason.
C(.PA$' APP"CA$!

A1thori9ed Signat1re A1thori9ed Signat1re

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*ac0gro1nd Chec0 Per2ission Page 2 of >
Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United States & Canada and by nternational treaties. ! S
""E#A" A$% S!&C!"' P&()*!E% !( %S!&*U!E+ PU*"S)+ (,,E& ,(& SA"E+ "CE$SE (& SU*"CE$SE+ #-E (& %SC"(SE !( A$' (!)E&
PA&!'+ !)S P&(%UC! $ )A&% C(P' (& %#!A" ,(&.. A"" (,,E$%E&S /"" *E SUE% $ A C(U&! (, "A/.
*ac0gro1nd Chec0 Per2ission Page > of >