CRIMINAL BACKGROUND CHECK AUTHORIZATION
Current Address Since
Previous Address From
If living at the addresses above for less than 7 years (combined), a third address is required.
The information contained in this form is correct to the best of my knowledge and any false information is automatic grounds for dismissal. I hereby give my consent for HEALTH-PRO Homecare Services, Inc. to run random Criminal Background checks of my record prior to, and/or after my employment, or regarding any suspensions or reports that may be brought to the Agency’s attention in the future.
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