Background Consent AGREEMENT, AUTHORIZATION AND CONSENT FOR RELEASE OF BACKGROUND INFORMATION:I,Name First Middle Last understand that in conjunction with my application for employment, work to be performed under contract, promotion, volunteer position, reassignment, and/or retention ("Work"), Maltique, LLC dba Sherwood Healthcare Center use the services of an outside agency to research and verify the information I have provided on my application for employment, including my personal background, character, professional work history and qualifications, This agency will provide a written report of its findings to Maltique, LLC dba Sherwood Healthcare Center uses ENZIO, a consumer-reporting agency, as an agent to perform its Employment related background investigations. ENZIO will various sources of information, It deems appropriate including but not limited to: criminal conviction records, current and former employers, department of motor vehicle records, military records, credit reporting agencies, education records, professional and personal references and compensation records including any and all injuries in compliance with the Americans with Disabilities Act. agree, authorize and consent to the release and disclosure of any and all information including but not limited to the above to Maltique, LLC dba Sherwood Healthcare Center, and ENZIO. I agree, authorize and consent to the procurement of a Consumer Report and/or an Investigative Consumer Report and understand that it may contain information about my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living, this authorization in original or copy form shall be valid for my term of Work from the date indicated next to my signature. According to the Fair Credit Reporting Act, I be notified Maltique, LLC dba Sherwood Healthcare Center if Work is denied because of information obtained from a Consumer Reporting Agency, Additionally, I understand that if requested within 60 days, I will be given a full and accurate disclosure as to the nature and substance of all information provided to Maltique, LLC dba Sherwood Healthcare Center I further understand that I may request a copy of the report, and that when doing so, proper identification will be required, and I should direct my request to: ENZIO. I understand that residents all states will automatically receive a copy of the report if an adverse action is taken regarding the employment application, or upon request as outlined herein,CHECK THIS BOX: IF are applying for work with a California, Minnesota or Oklahoma based employer and you would like a copy of your Consumer Report if one is prepared in the investigation of your background. CA Codes 1785.20.5 & 1785 & 1786.18(a)(5)(b)(1), MN Code 13C Subdivision 2, OK Code 24 0.S, 148 LAW ENFORCEMENT AGENCIES AND OTHER ENTITIES FOR POSITIVE IDENTIFICATION PURPOSES REQUIRE THE FOLLOWING INFORMATION WHEN CHECKING PUBLIC RECORDS, IT IS CONFIDENTIAL AND WILL NOT EIE USED FOR ANY OTHER PURPOSES, PLEASE PRINT CLEARLY.SIGNED: TODAY'S DATE: MM slash DD slash YYYY NAME as it appears on your Driver's License: POSITION APPLIED FOR: SOCIAL SECURITY NUMBER: DATE OF BIRTH: DRIVERS LICENSE NUMBER: STATE: OTHER NAMES THAT YOU HAVE USED, OR ALSO KNOWN AS, INCLUDING MAIDEN NAME, NAME CHANGES AND ANY ALIASES: Corporate Office: Cypress HealthCare Group 2266 Lava Ridge Ct. #105 Roseville, CA 95661 (V1 051322) Δ Sherwood Healthcare Center 4700 Elvas Ave.Sacramento, CA 95819tel 916-454-4700dmurray@cypressh.com Download Brochure Services Nursing Rehabilitation Activities Social Services