In connection with my application to render services to _____________________ (the "Company"), I hereby agree as follows:

As a condition of Company's consideration of my application to render services, I give permission to Company to investigate my personal and employment history. I understand that this background investigation will include, but not be limited to, verification of all information given by me to the Company.

I specifically give permission to Company to contact all of my prior employers and companies I have provided services to for references. I further give permission to all current or previous employers and/or managers or supervisors to discuss my relevant personal and employment history with Company, consent to the release of such information orally or in writing, and hereby release them from all liability and agree not to sue them for defamation or other claims based upon any statements they make to any representative of Company. I further waive all rights I may have under law to receive a copy of any written statement provided by any of my former employers or companies I have provided services to Company. I further agree to indemnify all past employers or companies I have provided services to for any liability they may incur because of their reliance upon this Agreement.

I further give permission to the Company to receive a copy of any information obtained in the file of any federal, state, or local court, or governmental agency concerning or relating to me. I further consent to the release of such information and waive any right under law concerning notification of the request for a release of such information. In the event a law does not provide for Company to have access to information, I hereby delegate the Company as my agent for the receipt of information. I understand that the scope of this investigation will be limited as required by applicable law.

I agree to fully cooperate in Company's background investigation, and to sign any waivers or releases that may be necessary or desirable to obtain access to relevant information. In the event that any former employer or other company or federal, state, or local governmental agency will not release reference information or criminal history information directly to the Company, I agree to personally request such information to the extent permitted by law.

This Agreement represents