Authorization and Release Statement


In connection with this application for employment, I authorize any employer, educational institution, law enforcement organization, state and federal government agency, information service bureau, and other persons contacted to release information regarding my character, performance, qualifications, background and reasons for termination of past employment to Alegent Health or its agent and I release all parties involved in providing said information from any and all responsibility or liability resulting from such investigation. I also authorize the release of my driving history, criminal records, credit history, and Consumer Investigative Report (“Report”) to Alegent Health. I understand the Report may contain information about my background, mode of living, character, and personal reputation. I understand Alegent Health may obtain a copy of the Report by contacting Hirease. I acknowledge that a facsimile or copy shall be as valid as the original. Prior to taking any adverse action based on the Report, Alegent Health will follow the process listed below as prescribed by the Fair Credit Reporting Act.

According to the Fair Credit Reporting Act, if any adverse decision is made with regard to application for employment, based entirely or in part on the information contained in a consumer report or investigative consumer report prepared by a consumer reporting agency, you are entitled to receive a copy of this report along with a Summary of Your Rights Under the FCRA.