Authorization for Investigation

AUTHORIZATION FOR RELEASE OF INFORMATION

In connection with my application for employment with Company X, Inc., I authorize Company X, Coast Guardian Investigations Inc. and its respective agents to solicit information about my background including, but not limited to, information about my employment, education, consumer credit history, driving record, criminal record and general public records history.

I also authorize the procurement of an investigative consumer report. I understand that such an investigative consumer report may contain information about my background, my mode of living, character, and personal reputation.

I release Company X, Coast Guardian Investigations Inc., its respective employees and agents and all persons, agencies and entities providing information or reports about me from any and all liabilities arising out of the release of any such information reports.

Name:_____________________ SSN______________________

Address_______________________________________________

Date of Birth____________________________________________

Driver’s License No.______________________

Signature______________________ Date____________________

Witness_______________________ Date____________________

Company X, Inc.