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71 views

Unsigned Document

Uploaded by

claireliujiaming
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CONSENT AND AUTHORIZATION:

I hereby provide my authorization and consent for HireRight, on behalf of Requestor to:

1. process my Personal Data in accordance with the verifications set out in the Information Notice and below:

• Managed The Customer has provided HireRight with criteria, guidelines and instructions to be used to determine whether the

Adjudication information in your Screening Report satisfies the eligibility criteria ("Adjudication Guidelines") for the Customer.

3.0 These Adjudication Guidelines are applied to the Screening Report information reported by HireRight and the

Customer receives a status that reflects the outcome of such application. Final status is determined solely by

Customer after review.

• Global This check confirms academic credentials by verifying relevant education as determined by the Requestor, for

Education example a degree, certificate or diploma claim directly with the awarding institution or its authorized agent

• Global A check to confirm your work history. You will be asked to provide company name, location dates worked and

Employment position or title held. This information will then be verified by contacting HR or official sources at each company to

be verified. The Requestor has also requested that your reason for leaving prior roles is collected. This list is a pre-

determined list and you will complete this within the screening form. The same list will then be sent to your prior

employers to complete. Any discrepancies will be notified to the Requestor. Self-employment (if applicable) will be

verified via documentation provided by you.

• Global A search of over 4000 registries held by international government and regulatory enforcement organizations will be

Sanctions & completed to identify restricted, sanctioned, and prohibited individuals. GSEC can also identify if you are a

Enforcement politically exposed person (PEP) and whether you appear on any negative media searches. Where information is

found reporting and matching guidelines will be applied and at least two unique identifiers must be present for a

result to be reportable e.g. name, D.O.B, ID number, address or employment history. You may request further

information in respect to the sources used.

• CDN CPIC Criminal History Search

National

Repository

for Criminal

Record

Search

2. contact Source(s) in order to verify the Personal Data provided by me during the screening process and to provide to Source(s) my:

a. name

b. date of birth

c. ID Number (where lawful); and

d. Supporting documents provided by myself or via my Prospective Employer during the pre-employment screening process

3. transfer the Personal Data (including sensitive Personal Data) outside of either the United Kingdom, the EEA or my country of

residence to Source(s) and/or Representatives, if required to complete the verifications;

4. store the Personal Data for a period of 36 months on the HireRight Portal;

5. to prepare the Report and share with my Prospective Employer.

I further authorise any third party source contacted by HireRight to respond to any enquiries made and to provide the Personal
Data requested of them, where applicable to the background screening. For the avoidance of doubt this may include:

• Current Employer

• Previous Employer

• Academic Institutions

• Professional Bodies

I confirm that my consent is provided voluntarily and that I understand that I can withdraw my consent at any time. To do so
please contact [email protected]

I declare to the best of my knowledge that any information that I have provided with my application for employment is true,
complete and correct.

Applicant Last Name ________________________


First ________________________

Middle ________________________

Applicant Signature___________________ Date_________________

Please print this page, sign, date, and fax to: 1-877-797-3442.

If outside the US, please fax to +1 949-224-6020.

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