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BACKGROUND CHECK AUTHORIZATION

The information contained in this application is the correct to the best of my knowledge. I hereby authorize (Harbor Grace Hospice) and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigate consumer report to be generated for employment and/or volunteer purposes. I understand that the scope of the consumer report/investigate consumer report may include, but is not limited to the following area: verification of social security number, credit reports, current and previous residences, employment history, education background, character references; drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records.

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 which the individual, company, firm, corporation, or public agency ma have, to include information or data received from other sources.

**(Harbor Grace Hospice) and its designated agents and representatives shall maintain all information received from this authorization in a confidential manner in order to protect the applicants personal information, including, but not limited to addresses, social security numbers, and dates of birth.