KidCheck Background Check Form

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Background Check Application KidCheck Background Check Terms of Use: As an applicant and/or purchaser of a KidCheck background check I have read, understand and agree to the following terms, acknowledgements, and disclaimers. I attest that I am requesting this background on myself and have not falsified my identity to obtain a background check on anyone other than myself. The information provided to KidCheck, Inc. (hereinafter, "The Company") is true to the best of my knowledge and belief. I understand and agree that all information furnished in my application and all attachments may be verified by The Company or its authorized representative. I hereby authorize all individuals and organizations named or referred to in my application and any law enforcement organization to give The Company all information relative to such verification and hereby release such individuals, organizations, and The Company from any and all liability for any claim or damage resulting therefrom. I hereby acknowledge that I have been informed by The Company that The Company may seek to obtain a consumer report and/or investigative report that will include personal information regarding me, including but not limited to, educational history, work references, driving record, and criminal convictions or arrest records if allowed, in order to assist The Company in completing a thorough background investigation. I further acknowledge notification by The Company that reports may be provided to The Company by other firms subcontracted for that purpose. I, my heirs, assigns and legal representatives, hereby release and fully discharge The Company, its parent and affiliated companies and the respective officers, directors, shareholders, employees, agents of each, including subcontractors, from any and all claims, monetary or otherwise, that I may have against The Company, its parent, affiliates or subcontractors, arising out of the making, or use of, either a consumer report and/or investigative report, including any errors or omissions contained or omitted from such reports or investigations. Organizations – Employees, Contractors and Volunteers As an organization utilizing the services of KidCheck, the applicant (hereinafter, "The User") agrees to the following disclaimer. All reports will be subject to the following conditions. All reports will be kept strictly confidential, no information from reports will be revealed to any other person, except a person whose duty requires him to pass on the transaction in relation to which the report was ordered. Reports will be used for employment purposes, or in connection with a legitimate business or

Background Check Application association's need in connection with transactions involving the consumer or public. The User agrees to comply with any applicable state requirements. The User agrees to hold KidCheck Inc., its officers, employees and any company KidCheck Inc. uses to obtain reports, harmless from and against any expense or damages resulting from the publishing of report information contrary to these conditions. The User understands that all information provided by KidCheck, Inc. is only current as of the date provided and is made available on an "as is" basis. I understand that the organization requiring this check will automatically have access to my report once it is submitted through KidCheck. I also understand that my school, employer, or organization may have authorized other entities to view my report, such as hospitals, clinical sites, or employers if I am a contractor. NOTICE: The User understands that KidCheck cannot be responsible for the record keeping practices of third parties such as, but not limited to; the Department of Motor Vehicles, county, state and federal courts, state repositories, state and regional prisons, local police stations, federal bankruptcy courts, federal civil courts, state medical boards, drug testing facilities and other professional licensing organizations, and other local, state and federal organizations. The undersigned recognizes that information is secured by and through fallible human sources. The User agrees to release KidCheck, its officers and employees from liability for any errors and or omissions contained in reports and from any loss or expense suffered by The User directly or indirectly from KidCheck reports. The User agrees that this letter constitutes all conditions of service and of reporting, present and future applies to all reports made by KidCheck Inc. and is binding in all 50 states.

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Social Security Number

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