Background Check Disclosure
Premier Island Management Group (the “Company”) may order a “consumer report” (a background report) or “investigative consumer
report" on you in connection with your employment application, and if you are hired, or if you already work for the Company, may order
additional background reports on you for employment purposes, to the maximum extent permitted by applicable law.
The background check company, ADP Screening and Selection Services, will prepare the background report for the Company. ADP
Screening and Selection Services is located at 301 Remington Street, Fort Collins, CO, 80524, and can be reached by phone at 800-
367-5933 or at their Internet Web site address www.adpselect.com.
The background report may contain information concerning your character, general reputation, personal characteristics, mode of living,
criminal history, and credit standing. An “investigative consumer report” is a background report that includes information from personal
interviews. Information may be obtained from private and public sources and for investigative consumer reports from personal
interviews as noted above. You may request more information about the nature and scope of an investigative consumer report, if any,
by contacting the Company.
Prior to Premier Island Management Group, LLC implementation of any adverse employment action, you will be provided with a copy of the report.
Furthermore, your rights under the Fair Credit Reporting Act, Section 609, will be made available to me on request.
Background Check Authorization
I authorize the Company to obtain my background report, including investigative consumer reports. I also agree that a copy of this form
is valid like the signed original. I understand that, as allowed by law, the Company may rely on this authorization to order additional
background reports, including investigative consumer reports, (1) during my employment and (2) from companies other than ADP
Screening and Selection Services without asking me for my authorization again, as allowed by law. I understand the Company may
order a background report under my legal name and any other names I may have used.
I also authorize the following agencies and entities to disclose to ADP Screening and Selection Services and its agents all information
about or concerning me, as allowed by law, including but not limited to: my past or present employers; learning institutions, including
colleges and universities; law enforcement and all other federal, state and local agencies; federal, state and local courts; the military;
credit bureaus; testing facilities; motor vehicle records agencies; if applicable, worker’s compensation injuries; all other private and
public sector repositories of information; and any other person, organization, or agency with any information about or concerning me.
The information that can be disclosed to ADP Screening and Selection Services and its agents includes, but is not limited to,
information concerning my employment history, earnings history, education, credit history, motor vehicle history, criminal history,
military service, professional credentials and licenses and substance abuse testing.
The information requested below is collected solely for the purpose of aiding the Company in running a background check in connection with your application for employment.
The employer is requesting that you provide this information to assist in conducting a thorough background check.
Please sign below to indicate that you have been made aware of this investigation and that further information has been offered you.