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Background Check Authorization

Please read the background check authorization below, then fill in your name and current date. By checking "I Agree to Terms Below", your authorization will be e-mailed to AllStar Staffing
 
Certification and Acknowdgements
Certification of Information
I understand that I am applying for employment with Clinton Staffing Company, doing business locally through AllStar Staffing, hereinafter jointly referred to as “AllStar Staffing.” By signing below, I declare that the information I have provides in the application process is complete and true to the best of my knowledge. I understand and agree that any false information, will result in dismissal at any time during my employment.
 
Application and Equal Opportunity
AllStar Staffing is an Equal Employment Opportunity company. All qualified applicants will receive consideration without regard to gender, marital status, race, color, age, creed, religion, national origin, veteran status or disability. I understand that this form is for use in evaluating my qualifications for employment; it is not an offer or a promise of employment. A background investigation, interview, reference check, various tests and a policy review may be required before any final determination of my suitability for employment is made.
 
Drug Use and Test
I understand that AllStar Staffing prohibits the use of illegal drugs. I am willing to provide a urine, blood, hair or saliva specimen for drug and/or alcohol testing prior to and/or during my employment as a condition of assignment to certain job positions, or if there is any reason whatsoever to suspect drug or alcohol use. I understand that company policy requires a drug test and alcohol test whenever there is a on-job accident or injury. The drugs that will be tested for are Amphetamines, Barbituates, Benzodiazepines, Cocaine, Methadone, Methaqualone, Propoxphene, Phencyclidine, Opiates including morphine and codeine, and Cannabinoids and any hemp product. We may also perform tests to detect adulterants or substances to mask the detection of drugs. To be qualified for employment with AllStar Staffing we must receive a “negative” report on the drug screen. If that qualification is not met, the prospective employee that has been extended and offer will be withdrawn. I hereby release AllStar Staffing, it’s clients and any clinic, individual or test product manufacturer that may administer or provide a drug or alcohol test from any and all claims arising out of the results of such a test, and from any action taken on the basis of those results.
I am voluntarily signing below to acknowledge that I have read and fully understand the certification and acknowledgements above. I have the opportunity to ask questions before signing, and all explanation has been in a language I understand.
 
Release of Information
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 AllStar Staffing or it’s agents. 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.
I hereby release AllStar Staffing, the Social Security administration, and it’s agents, officials, representatives, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may at any time, result to me, my heirs, family, or associates because of the compliance with this authorization and request to release. You may contact me as indicated below.

I understand this authorization automatically expires 90 days from the date executed below and that I have the right to revoke the authorization at any time, provided I do so in writing.

I acknowledge this is an electronic signature
*Signed Name: Date:
Former Name(s): Dates Of This Name Used:
Note: No less than 7 years of address history required
Current Address Since:
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*(mm/yy) *County *City/Country *State
Previous Address From:
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(mm/yy) County City/Country State
Previous Address From:
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(mm/yy) County City/Country State
*Date of Birth: Month:  Day:  Year:
I am currently employed?
If yes, I approve AllStar Staffing contact my current employer for a reference?
* I Agree to the Terms Above