Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Available Start Date

MM

DD

YYYY

Employee Intake: Informed Consent *

I hereby give STRIVE MN the right to make a thorough investigation of my past employment, education, and activities. I release STRIVE MN and/or its agents from all liability to retrieve information from any/all government agencies, social service agencies, and law enforcement agencies, to supply any and all information concerning my background, and release the same from any liability resulting in providing such information. STRIVE MN does not run credit reports, but is required to conduct criminal conviction searches during the hiring process. I understand that I am required to pass a criminal background check by the Minnesota Department of Human Services and understand that if for any reason I would be disqualified, STRIVE MN cannot proceed with my employment. I understand that if my application for employment is granted STRIVE MN may obtain further information through subsequent investigations by a consumer reporting agency so as to evaluate me in regard to promotion, reassignment, retention, and to comply with operating license and/or liability insurance requirements and/or applicable state/federal laws. This includes initial and annual criminal conviction searches as well as investigations resulting from possible employment misconduct, negligence, and/or incidences/accidents involving my employment with STRIVE MN, its clients, consumers, agents and/or assigns. This document is valid throughout the course of my employment. I understand that the disclosure of a criminal record will not automatically disqualify me from employment consideration and that my case will be judged on its merits and according to MN DHS rules and regulations. I understand that any false answers, statements, or implications made by me in any application or other required documents, or acts of willful misconduct pertaining to my employment shall be considered sufficient cause for denial or employment discharge. I hereby release any individual or institution, including its officers, employees, or related personnel, birth individually and collectively, from any/all liability for damages of whatever kind, which, at the time result to me, because of compliance with this authorization and request to release information or any attempt to comply with it. I understand that a consumer and/or investigative consumer report for the purpose of employment will be obtained.

I consent to the above informed consent information.

I do not consent to the above consent information. I do not want to proceed with the application.