Applicant

Field Required.
Field Required. No spaces or symbols!
Field Required.
Field Required.
Field Required.
Field Required.
Field Required.
Field Required.

Veterinary Qualifications

First Work Experience

Field Required.
Field Required.
Field Required.
Field Required.
Field Required.
Field Required.

Second Work Experience

Field Required.
Field Required.
Field Required.
Field Required.
Field Required.
Field Required.

Third Work Experience

Field Required.
Field Required.
Field Required.
Field Required.
Field Required.
Field Required.

Education History

Field Required.

Technical Skills

Interest in Position

Field Required.

Other Information

First Reference

Field Required.
Field Required. No spaces or symbols!

Second Reference

Field Required.
Field Required. No spaces or symbols!

Third Reference

Field Required.
Field Required. No spaces or symbols!

Authorization of a Background Check

NOTICE, AUTHORIZATION AND RELEASE FOR THE PROCUREMENT OF A
CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT

I, the undersigned job applicant, do hereby authorize the Texas Coalition for Animal Protection ("TCAP") to procure a consumer credit report and/or background report on me for employment purposes from HireRight, Inc. ("HireRight"). I understand that this authorization and release shall be valid for subsequent consumer credit and/or background reports during my period of employment with TCAP for the purpose of investigating any incidents of workplace misconduct or criminal activity for which I am alleged to have been involved during my employment.

These above-mentioned reports may include, but are not limited to, information as to my character, general reputation, and personal characteristics, discerned through employment and education verifications; personal references; personal interviews; my personal credit history based on reports from any credit bureau; my driving history, including any traffic citations; a social security number verification; present and former addresses; criminal and civil history/records; and any other public record.

I further authorize any person, business entity or governmental agency who may have information relevant to the above to disclose the same to TCAP and/or its representatives, including, but not limited to any and all courts, public agencies, law enforcement agencies and credit bureaus, regardless of whether such person, business entity or governmental agency compiled the information itself or received it from other sources. Furthermore, I hereby release from liability and hold harmless all persons, organizations, agencies, or institutions supplying this information in their possession to TCAP and/or its representatives. I direct you to release such information upon request of the designated representative of TCAP, regardless of any agreement I may have made with you previously to the contrary.

I have read this Authorization and Release and agree with its provisions. I understand that I am entitled to a complete and accurate disclosure of the nature and scope of any consumer report prepared by HireRight of which I am the subject upon my written request to HireRight, if such is made within a reasonable time after the date hereof. I also understand that I may receive a written summary of my rights under 15 U.S.C. § 1681 et. seq.

Further, I certify that the information contained on this Notice/Authorization/Release form is true and correct and that my application or employment may be terminated based on any false, omitted, altered, misleading, or fraudulent information.

Field Required.