954-749-4059 · 561-883-9291 · 407-282-8887

NATIONAL CRIMINAL BACKGROUND CHECK CONSENT FORM

Pursuant to the federal Fair Credit Reporting Act, I hereby authorize Elite Music Instruction, Inc. and its designated agents and representatives to conduct a comprehensive review of my background through a consumer report and/or an investigative consumer report to be generated for employment, promotion, reassignment or retention as an employee. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: verification of Social Security number; current and previous residences; employment history, criminal history, including records from any criminal justice agency in any or all federal, state or county jurisdictions; birth records; motor vehicle records, including traffic citations and registration; and any other public records. I,

authorize the complete release of these records or data pertaining to me that an individual, company, firm, corporation or public agency may have. I hereby authorize and request any present or former employer, school, police department, financial institution or other persons having personal knowledge of me to furnish Elite Music Instruction, Inc. or its designated agents with any and all information in their possession regarding me in connection with an application or continuation of contracting. I am authorizing that the electronic version of this authorization be accepted with the same authority as a paper version. I understand that, pursuant to the federal Fair Credit Reporting Act, if any adverse action is to be taken based upon the consumer report, a copy of the report and a summary of the consumer's rights will be provided to me.

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Today's Date

Date of Birth

954-749-4059
561-883-9291
407-282-8887

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