Thank You CAHR Application

LEWISTON-CLARKSTON PARTNERS HABITAT FOR HUMANITY AFFILIATE FAMILIES
SUBJECT RELEASE AND AUTHORIZATION

Transparent Information Services, LLC (TIS) is hereby authorized to conduct a background investigation on me in the course of consideration as an affiliate family of Lewiston-Clarkston Partners Habitat for Humanity. I voluntarily and knowingly authorize,without reservation, any duly authorized agent of TIS to obtain from any law enforcement agency, drug screening firm, state, county or federal agency, present employer or supervisor, landlord, past employer or supervisor, finance bureau/office, credit bureau, collection agency, college, university or other institute of learning or certification, private business, military branch or the National Personnel Records Center, personal reference and/or other persons , and voluntarily and knowingly authorize the same to give, records or information that they may have concerning my criminal history, motor vehicle history, earnings history, credit history, character, employment records, record of attendance and earned degrees or certificates, or any other information requested, whether the said records are public or private, and including those which may be deemed to be privileged or confidential in nature and I voluntarily, knowingly and unconditionally release all such persons, including any named or unnamed informant, from any and all liability resulting from the furnishing of this information. A photographic, faxed or e-mailed copy of this authorization shall be as valid as the original.

Transparent Information Services, LLC is only an information provider and does not make leasing decisions

FULL NAME

First

Last

FORMER/MAIDEN/ALIAS/OTHER NAMES USED

Email

ADDRESS HISTORY FOR THE MOST RECENT 7 YEAR PERIOD:

ADDRESS(1)

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

DATE OF RESIDENCE(1)

ADDRESS(2)

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

DATE OF RESIDENCE(2)

ADDRESS(3)

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

DATE OF RESIDENCE(3)

ADDRESS(4)

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

DATE OF RESIDENCE(4)

DRIVER'S LICENSE NUMBER

STATE

NAME AS IT APPEARS ON LICENSE

SOCIAL SECURITY NUMBER

DATE OF BIRTH

SEX

RACE

**THE INFORMATION PROVIDED ABOVE IS FOR THE PURPOSES OF INITIATING A BACKGROUND CHECK AND Will NOT BE USED BY THE PROSPECTIVE LANDLORD IN THE LEASING DECISION**

I understand that the information that I have provided is for the purposes of a background check only. TIS, LLC is a background screening company, not owned or operated by the Habitat for Humanity. I further acknowledge that my date of birth, sex and race are to be used for investigative purposes by TIS, LLC where this search criteria may be required by certain agencies listed in the top paragraph of this form and shall not be used for the purpose of making a hiring decision.

CALIFORNIA, OKLAHOMA, and MINNESOTA RESIDENTS ONLY: If you are a current California, Oklahoma, or Minnesota resident and would like to request a copy of your Consumer Report or Investigative Report, please check the box. This report may include character and reputation information obtained through personal interviews.

ELECTRONIC SIGNATURE

DATE

Thank you for your application. Please fill-out the form below to complete.