* = Required Information
Criminal Background Check Release Form
I understand that a criminal background check is a requiremnet for being considered for employment or volunteering with
lnfiniti Home Healthcare
.
I consent to
lnfiniti Home Healthcare
causing a criminal background check to be run on me by the Colorado Bureau of Investigation(CBI) and/or the Federal Bureau of Investigation(FBI).
I hereby fully release and discharege
lnfiniti Home Healthcare
and its officers, agents, ang employees from any and all claims for damages which may arise from participating in or as a result of the criminal background check.
I understand that
lnfiniti Home Healthcare
will keep this form on file in my personel record for a minimum of two (2) years.
List any other names or aliases by which you have been known:
Date of Birth
*
Gender
Male
Female
Drivers License Number
Social Security Number
Address
*
I had read and fully understand this release form.
Name (please print)
*
Signature
Date
*
Name of Witness (please print)
*
Title of Witness
Signature of Witness
Date
*
Submit