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AUTHORIZATION FOR
RELEASE OF INFORMATION – Please read and initial to be considered for
employment through Brigham Group Staffing (Brigham).
I certify that the
statements I have made while completing this online (electronic)
application form are true and correct and without material omission. I
understand that making false statements or omitting pertinent facts is
sufficient cause for rejection or dismissal from employment. I authorize
obtaining information from any person(s), employers, educational
institutions, licensing authorities, and/or law enforcement agencies
concerning my background, work habits, skill or conduct on the job, with
the exception of past employer(s) I have indicated that are not to be
contacted. I hereby release such person or entities from all liability
for damages for issuing such information.
If and when I am
employed by Brigham, I agree that if at any time I make claims for
personal injuries, I will submit myself, upon written request, to
examination by a physician or physicians of Brigham's selection, at
their expense, as often as may be requested.
I also agree that
if I am employed, now or at any time in the future, my employment is “at
will,” which means that it is not for any fixed period of time and may
end at any time without liability to me for wages or salary except for
such wages or salary earned prior to the date of my termination. I
understand the term of my employment shall be limited to the duration of
any assignment(s)
that I accept.
I am aware that
Public Law 91-508, known as the Fair Credit Reporting Act, requires the
employer to inform me that a routine inquiry may be made that will
provide applicable information concerning my character, my general
reputation, my personal characteristics and my credit history. Further
information may be available upon request and this authorization shall
be valid for this and any further requests. I understand I have the
right to make a written request within a reasonable period of time to
receive additional detailed information about the nature and scope of
the investigative report.
I understand that I
am applying for temporary or contract assignments, subject to my
availability and the availability of customer assignments calling for
the skill and qualifications that I possess, and I agree to consider
acceptance of such assignments. If I work for Brigham Group Staffing, I
will obtain permission from Brigham Group before discussing direct
employment with Brigham’s clients. I will keep confidential all
information I learn while employed for Brigham Group regarding them
and/or any clients or candidates of Brigham. I will notify Brigham when
my temporary assignment ends. If I don’t, it means that I am not
available for work. I understand my failure to report for work at the
assigned company will indicate that I have quit.
I also authorize
Brigham Group Staffing to release the information contained herein and
its findings and work history of my employment to other firms upon
request.
I agree that a
photocopy, fax or electronic copy or printout of this authorization will
also serve as an original document, and my initials below indicate my
permission for any release of information concerning any of the work-
and background-related items listed above.
Please take a
moment to review your application. Indicate that you have read the above
statement by entering your initials in the box below. To complete
this application, initial the box below, and click on the Submit
Application button.
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