BACKGROUND HISTORY VERIFICATION WAIVER & RELEASE FOR CONFIDENTIAL RECORDS

I, _____________________, hereby authorize The Hawkins Firm, Inc., its subsidiaries, affiliates, employees and agents to conduct a complete, unlimited background investigation on myself. I fully understand and authorize the making of inquiries of and request for information from, but not limited to, any individuals, present and former employers, schools and colleges, credit bureaus, medical information bureaus, criminal investigation bureaus, courts, local, state and/or federal agencies, and any other entities that may possess information concerning me.
I also authorize the above described sources to release all information requested and I release those sources from any liability arising from any information released that stems from this request. I understand that such records may include, and I specifically authorize the company to perform the following checks on my credentials: reasons for termination of employment, reasons for discharge from military service, criminal history record to include any and all arrest and conviction records, worker’s compensation claim files, educational records, motor vehicle reports, credit reports and any other information the company deems appropriate and that would not otherwise be obtainable without my prior consent.
I understand that the information that is obtained from this background investigation is limited to the use of this background investigation. The Hawkins Firm, Inc., its subsidiaries, affiliates, employees and agents are held under the conditions of confidentiality. The client assumes responsibility for the subsequent use or disclosure of the background investigation.
Furthermore, I agree to hold harmless The Hawkins Firm, Inc. et al for any and all actions of their client(s) that do not conform to any and all local, state, or federal laws, regulations, labor agreements, or other similar legal requirements. I certify that all statements made by me herein are true and correct.

Signature: X_______________________________________
Last
 
First
 
Middle
 
Alias/Maiden Name (If Applicable)
 
Sex
 
Race
 
Date of Birth (MM/DD/YY)
 
Social Security Number
 
Driver's License Number
 
State of Issue
 
Full Name as it appears on Driver's License
 
Degree/Major
 
Name & Address of University
 
Dates
 
Degree/Major
 
Name & Address of University
 
Dates
 
Current Address
 
City/State
 
Zip
 
Phone
 
Dates
 
Previous Addresses (Past 5 yrs)
 
       
         
         
         
Previous Employers (Past 7 yrs)
 
       
         
         
         
FOR OFFICIAL USE ONLY (CIRCLE) CRIMINAL CREDIT MVR EMP VER ED VER
** Please attach a copy of current driver’s license for person/persons signing on the signature line.
THE HAWKINS FIRM CORPORATE OFFICE:
883 COMMERCE DRIVE, SUITE 200, CONYERS, GEORGIA 30094
TELEPHONE: 770/760-0071 FACSIMILE: 770/760-0531
THE HAWKINS FIRM ATLANTA OFFICE:
400 GALLERIA PARKWAY, SUITE 1500, ATLANTA, GEORGIA 30339
TELEPHONE: 770/951-2121 FACSIMILE: 770/951-2128