Background Form

PRE-EMPLOYMENT AND CONTINUED EMPLOYMENT DISCLOSURE

AUTHORIZATION AND RELEASE

I understand that in connection with my application for Employment, and /or for Continuous Employment, with Camp Fernwood, Inc., IntelliCorp, their agents, assigns or any other authorized third parties (collectively, the “Investigators”) may be performing, requesting, obtaining or conducting a background check on me.  This background check may include an inquiry into my Employment History, Education, General Character or Reputation, Work Experience, Volunteer Experience, Driving, and/or Criminal History.  However, unless my position involves handling money or having access to monies and /or other transferable monetary instruments, my Credit History will not be checked.

I understand that Camp Fernwood, Inc. may rely on any part or all of this Information in determining whether to extend an offer of Employment to me.  I further understand that if any adverse action is taken by Camp Fernwood, Inc., or if Camp Fernwood, Inc. chooses not to extend an offer of Employment to me based upon the information, that I will be provided a copy of such Information along with a summary of my rights under the Fair Credit Reporting Act.

I understand that the background check, which may be performed by Investigators, is being performed as part of the process to evaluate me prior to Employment, and is not conducted for any purpose other than in connection with my Application for Employment, and/or my eligibility for Continued Employment.

I have read this Pre-Employment and Continued Employment and by accepting below, hereby authorize Investigators to conduct a background check as described herein in conjunction with my application for employment.  I hereby release any and all Investigators, from any and all liability related to the procurement or disclosure of any information provided by me or obtained about me in connection with my Application with Camp Fernwood, Inc..  I further direct and authorize Investigators to conduct the background check and further authorize any third parties who may be the custodians of or in possession of the requested Information, to disclose such Information to Investigators in connection with this background check.

Although furnishing your Social Security Number is not optional, it shall be used for NO other purpose than to make the process for conducting a background search more accurate.  It shall not be sold, or in any way transferred to a third party except for the express purpose of conducting the background check.