I, hereby authorize ________________________________, it’s subsidiaries, affiliates, employees and agents, to make inquiries of and obtain consumer credit reports for employment purposes from the credit bureaus. I hereby release those sources from any liability for doing so.

I give this authorization in connection with an application/resume relating to employment.

Applicant’s Signature:___________________________________________________

Name (please print):_____________________________________________________

Current Address:_____________________________________Dates:_____________

Previous Address:____________________________________Dates:_____________

Social Security #: __________ - _______ - __________

Please fax this signed Authorization Form
to BEARAK REPORTS at 508-788-6642.