(Used Within the Last 7 years E.g. Maiden, Other Married Names)
DISCLOSURE AND AUTHORIZATION (IMPORTANT – PLEASE READ CAREFULLY BEFORE SIGNING AUTHORIZATION)
DISCLOSURE REGARDING BACKGROUND INVESTIGATION
Personal Care Services Midsouth, LLC, may obtain information about you from a consumer reporting agency for Employment purposes. Thus, you may be the subject of a “consumer report” and/or an “investigative consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living and which can involve personal interviews with sources such as your neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records (“driving records”), verification of your education or employment history, or other background checks. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report. If needed contact Personal Care Services MidSouth, LLC, 1723 Hwy 51 S. Ste. E, Covington, TN 38019 or 901-313-9238.