Customer Care Advisor

I understand that for this purpose GoodLeap or persons acting on its behalf will be requesting information from various federal, state, and local governmental agencies, previous employers and their employees, personal acquaintances of mine, and other appropriate resources of information that maintain records or possess knowledge about my education, employment, criminal, driving and other relevant activities, experiences and records, including, but not limited to, my character, general reputation, personal characteristics, and mode of living.

I authorize, without reservation, any person or entity contacted by GoodLeap or anyone acting on its behalf, to furnish the above-stated information, and I release any such person or entity from any and all liability for furnishing such information. I also release GoodLeap from any and all liability for conducting such an investigation.

I authorize GoodLeap to disclose my Social Security Number in order to obtain necessary information.

I understand that if I refuse to execute this authorization, GoodLeap may refuse to grant employment based on this refusal.

(Please initial.)