(Please print out this form, sign it, and fax it back ASAP to 208-723-6105)

As an applicant pursuing a contract to become an Independent Contractor Online Tutor with, I understand that an investigative report may be generated on my background including but not limited to social security verification, educational verification and criminal background history. I understand that has contracted with General Information Services to generate this investigative report. I fully give my consent to and understand that General Information Services on behalf of may be requesting information from public and private sources about any of the information noted above in connection with’s consideration of me for contractor status now or at any time during my tenure with This document is a hard copy of the consent. Applicants should retain a copy. According to the Fair Credit Reporting Act (FCRA, Public Law 91-508, Title VI) which was revised effective September 30, 1997, I am entitled to know if the consideration for which I am applying is denied because of information obtained from a consumer reporting agency. If so, I will be notified and be given the name of the agency providing that report. I acknowledge that a telephonic facsimile (FAX) or photographic copy of this release shall be as valid as the original. This release is valid for most federal, state and county agencies including the Minnesota Department of Labor I understand that if I am a resident of Minnesota/Oklahoma (only) I may obtain a copy of the report ordered, and now indicate my desire to do so by checking this box . California applicants or employees only: By signing below, you also acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check this box if you would like to receive a copy of an investigative consumer report if one is obtained by the Company at no charge whenever you have a right to receive such a copy under California law. □ New York applicants only: You have the right to inspect and receive a copy of any investigative consumer report you have requested by contacting General Information Services directly. I HAVE READ, UNDERSTAND, CONSENT AND AUTHORIZE ANY PERSON, AGENCY OR OTHER ENTITY CONTACTED BY GENERAL INFORMATION SERVICES, OR ITS AGENTS, TO FURNISH THE ABOVE MENTIONED INFORMATION

I DECLINE the release of background information. I understand that it will result in my application for a contract being withdrawn from consideration
I hereby authorize, without reservation any law enforcement agency, information service bureau or school contacted by General Information Services, Inc. to furnish the information described above.
_________________________________________ SIGNATURE ___________________________________________ TYPE OR PRINT NAME (last, first, middle initial) CURRENT AND PREVIOUS ADDRESSES ____________________ SOCIAL SECURITY # _________________ ________ DATE OF BIRTH (MONTH/DATE/YEAR)

_________________________________________________ OTHER NAMES USED (alias, maiden, nickname)

(You may attach an additional sheet, if necessary)

______________________________________________________________________________________________________________ STREET/P.O. BOX CITY STATE ZIP COUNTY OF RESIDENCE

Have you ever been convicted of any Criminal Violation of the law other than a minor traffic violation or are you now under pending investigation or charges? yes no if yes, please attach full and complete explanation as well as any supporting documentation.
HIGHEST EDUCATIONAL INSTITUTION ATTENDED/CURRENTLY ATTENDING: ______________ CITY AND STATE ADDRESS OF EDUCATIONAL INSTITUTION: ___________________________________ _________ _____________________ __

HIGHEST DEGREE RECEIVED/ EXPECTED AND DECLARED MAJOR: _________________________________________________ DATES ATTENDED: ________________________ GRADUATED: YES NO IF YES, GRADUATION DATE:_______

__ ___ ___ ____ ______

IF YOU HAVE NOT YET GRADUATED, WHAT IS YOUR CLASS STANDING? (Ex. Sophomore, Junior) _________________________

You may withdraw your consent to the release of background information address by contacting at