Background Check Form

Employee Authorization to Release Records

I understand and agree that: The information supplied, was submitted by myself, and all information is true and correct, to the best of my knowledge. I understand that false or misleading information given i my application and/or interview(s) will be considered as cause for possible dismissal and/or discharge. I also understand that i am to abide by all rules and regulations of the company. The company has my authorization to thoroughly investigate my work and person history. I understand that the information supplied by me, regarding my: Employment History, Education (including an authorization to release transcript(s), Credit History, Criminal History, Medical and Professional Licensing, Motor Vehicle Record(s), Residence History, and References will be utilized as part of the processing procedures. A background check will be conducted to verify the veracity of the information submitted and will be utilized to develop information concerning my character, general reputation, personal characteristics, and mode of living. I hereby authorize SentryLLC, an agent of Riegler Blacktop to make a thorough check of my past employment, education and activities.



Starting with current

Current Employer

The following information is used for identification and statistical purposes. It is not used in any manner considered discriminatory under EEOC guidelines

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