DISCLAIMER

By completion and submission of this form, I hereby authorize without reservation 24/7 Drug & Alcohol Testing Center and their representative agents, and Company/School noted above to receive any background check results pertaining to me.  I grant 24/7 Drug & Alcohol Testing Center permission to perform a background check using the information I have provided them.

I release Client Company and 24/7 Drug & Alcohol Testing Center their respective employees, agents, and all persons, agencies and entities providing information or reports about me from any and all liability arising out to the release of any such information.  I understand that if I am under the age of 18, I must have my parent, or my legal guardian grant their permission for the background check to be performed.

The information provided above will be used solely for the service intended and will be kept in confidence. All background information will be forwarded to the authorized personnel for completion of pre-employment  or clinical rotation application. If you have any questions or need any additional information please feel free to contact our office or email us at [email protected]
NATIONAL BACKGROUND CHECK CONSENT FORM
FIRST NAME
CURRENT ADDRESS  (INCLUDE CITY, STATE AND ZIP)                                                                   
EMAIL ADDRESS
DAYTIME NUMBER
email me
DATE OF BIRTH  (MM/DD/YY)
NAME OF SCHOOL
MIDDLE
(If no middle NAME please type NONE)
LAST NAME
Drug & Alcohol Testing Center
(404) 963-5767
TEL : (404) 963-5767             FAX: (866) 485-7070              email: [email protected]