BACKGROUND CHECK DISCLOSURE

AND AUTHORIZATION DISCLOSURE

As part of the employment process, Lakewood Retreat will do Background Checks, which I understand may include information regarding my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living.

AUTHORIZATION

During the application process and at any time during the tenure of my employment paid or volunteered with the Lakewood Retreat, I hereby authorize CampBackground Checks on behalf of Lakewood Retreat to procure a report which I understand may include information regarding my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. This report may be compiled with information from credit bureaus, courts record repositories, departments of motor vehicles, past or present employers and educational institutions, governmental occupational licensing or registration entities, business or personal references, and any other source required to verify information that I have voluntarily supplied. I understand that I may request a complete and accurate disclosure of the nature and scope of the background verification to the extent such investigation includes information bearing on my character, general reputation, personal characteristics or mode of living.

Your submission of this form constitutes your authoriztion of the background check to be prerformed as described above.

Clicking the submit button below will send this form to a secure terminal at Lakewood Retreat for confidential processing. Any questions may be directed to Human Resources at Lakewood Retreat

25458 Dan Brown Hill Rd

Brooksville, FL 34602. Phone 352-796-4097

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