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Client and Applicant Instructions

Canada
For CRIMINAL RECORD REPORTS, the applicant will have to follow the instructions below:
1.

Please read, complete and sign the Disclosure and Authorization


International Supplement (form attached).
a. It is important for the applicant to provide ALL of the information required
on the form.

2.

Please complete and sign the Special Letter of Authority (form attached).
Please note that applicants are required to provide a physical residential
address in Canada.

Please scan and email the required documents to:


InternationalForms@verificationsinc.com
Or Fax Documents to:
605-884-1310

Please be aware that international background checks often take longer than checks done in
the United States.

Verifications Inc.
1425 Mickelson Drive
Watertown, SD 57201
Tel: +1 605 884 1200 Fax: +1 605 884 1140
Canada-AplInstr-2012-05-29

Source: Verifications, Inc., BGI Only, Version 2012-May-29

Consumer Report/Investigative Consumer Report


DISCLOSURE AND AUTHORIZATION INTERNATIONAL
Through this document, it is being disclosed to me and I understand that a Consumer Report or Investigative Consumer Report
(Consumer Report) may be prepared about me as part of my application for employment and/or continued employment.
I authorize _____________________________________ to procure a Consumer Report which includes information from sources outside the
United States. I understand that the Consumer Report will be prepared by Verifications, Inc., and I authorize Verifications, Inc., a US-based Safe
Harbor Certified Consumer Reporting Agency, and its agents, to retrieve the necessary information and prepare a Consumer Report. I understand
and authorize that some or all of my information may be transmitted electronically and, when required, may be transferred across international
borders. I understand that Verifications may transmit my personal information to its agents and information sources as necessary throughout the
course of business and that host country and receiving country privacy laws will be observed if information is transferred across international
borders. I may request a list of designated agents by contacting Verifications, Inc. as listed below. I understand that my personal information will be
retained by Verifications in accordance with the US Fair Credit Reporting Act (FCRA), 15 U.S.C. 1681, et seq. Verifications is a Safe Harbor
Certified company and meets or exceeds the level of privacy protection required by the European Union and Switzerland. Verifications holds all
personal and private information it obtains securely and confidentially. I agree that Verifications, Inc. may disclose any or all information collected
about me to the above-named company.
I understand that my background investigation will be based on information that I provided in my Employment Application, Curriculum Vitae/Resume,
Disclosure/Authorization, and/or the information requested below (together called Source Documents). My personal information will not be shared
with any person, organization, or company other than those entities acting as an authorized agent of Verifications for the specific purpose of verifying
the information I provided unless required by law or I specifically authorize. As part of my Consumer Report, I authorize Verifications to obtain,
and the information sources to provide, the following types of information:

[Please mark the boxes for the categories you are authorizing Verifications to obtain. Leave any box you ARE NOT
consenting to blank as any mark will be considered evidence of consent.]
__Academic/Education
__Credit/Financial/Bankruptcy
__Criminal History

__Address Verification
__Professional
License
__References

__Driving Record

__Government Databases

__Media Search

__Employment

__Sanctions and Watch Lists

__Other:

__Executive Affiliations

__Identity Verification

I understand that a Consumer Report may be prepared summarizing information from these categories and I authorize educational institutions,
employers, government agencies, credit reporting agencies, companies, corporations, and law enforcement agencies at the international, federal,
state/provincial or county level to provide any and all information concerning my background. If my prior employers and/or references are contacted,
the Consumer Report may include information obtained through personal interviews regarding my character and general reputation. I understand
that the personal information described above is being collected, used and disclosed only for the purposes of assessing my suitability for
employment with the above-named company.
I may request a copy of any report that is prepared regarding me and A Summary of Your Rights under the Fair Credit Reporting Act. I may also
request the nature and substance of all information about me contained in the files of the consumer-reporting agency. I understand I have the right to
inspect those files with reasonable notice during regular business hours and I may be accompanied by one other person. I understand that I have the
right to dispute any information contained in the consumer report, if I believe it is false, inaccurate or misleading. The consumer-reporting agency is
required to provide someone to explain the contents of my file. I understand proper identification will be required and I should direct my request to:
Verifications, Inc., Applicant Services Department, 1425 Mickelson Drive, Watertown, SD 57201, USA. Phone 1-800-247-0717 / +1 605-8841200. For a copy of Verifications privacy practices, visit http://www.verificationsinc.com/eng/privacy.cfm.
This consent is effective from the date specified on this form until the date my employment application is accepted or denied by the above-named
company, or until I withdraw my authorization in writing. I acknowledge and agree that a photocopy of this authorization may be accepted with the
same authority as the original.
I authorize Verifications, Inc. to prepare a Consumer Report/Investigative Consumer Report on me, and I authorize the above-named
company to procure a Consumer Report/Investigative Consumer Report about me from Verifications, Inc.
Signature

Todays Date (spell month)

[Note to applicant: Please complete and submit the information requested on the following page. It will be used prepare your Consumer
Report and IS NOT considered as part of your application for employment or continued employment.]
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Source: Verifications, Inc., BGI Only, Version 2012-May-29

Personal Information Form:


The information requested below is needed to prepare your Consumer Report and IS NOT considered as part of your application for employment or
continued employment. It is used for identification purposes only. Please list your current address.
Full Legal Name

(No abbreviations; Please include all surnames)

Other Names Used (if different than above)

Date of Birth (spell month)

Street Address

State/Province

City

Country

ZIP/Postal Code

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SPECIAL LETTER OF AUTHORITY


Canada
I hereby request a report on myself, to include criminal information, and I give to Verifications, Inc., a
Minnesota company, its employees and its agents, the explicit authority to obtain the report with regards
to my job application with:
Employer

Position

My Personal Details
Full Legal Name (no abbreviations; please include all surnames)

Name Prior to Marriage (if different than above)


Date of birth

Place of birth

(day/month/year)

Sex (M/F)

Previous addresses in Canada are REQUIRED (post office boxes are not acceptable):

1.
Street Address
City
Dates of Residence

Province/Territory
(day / month/ year)

to

Dates of Residence

Postal Code
(day / month/ year)

2.
Street Address
City
Dates of Residence

Province/Territory
(day / month/ year)

to

Dates of Residence

Postal Code
(day / month/ year)

3.
Street Address
City
Dates of Residence

Province/Territory
(day / month/ year)

to

Dates of Residence

Postal Code
(day / month/ year)

The information is only to be used for the job application and CANNOT be used for any other purpose and
MUST be destroyed within the time required by the law. I certify that I am the person identified in this
authorization.

Applicants Signature

Applicants Printed Name

Date

Verifications Inc.
1425 Mickelson Drive
Watertown, SD 57201
Tel: +1 605 884 1200 Fax: +1 605 884 1140
Canada-CD-LOA 2012-05-29.doc