List below additional, current or formal employee references (not personal
Providing the information means that you give ORNA permission to
contact all names listed below if necessary
Please answer these questions in 1-2 sentences
Applicant: Please read the following:
This is to inform you that a background investigation will be conducted as part of
your pre-employment processing.
I AUTHORIZE all former employers, listed references, law enforcement agencies and
courts, credit bureaus, academic institutions, or other sources of information
pertaining to me to release and deliver such information upon request to Screening
Link acting on behalf of ORNA.
I AUTHORIZE ORNA to conduct a criminal history search, and other background checks
already enumerated above or as otherwise required, through Screening Link.
I understand that employment with ORNA or any of its affiliates or subsidiaries is
contingent upon successful completion of the pre-employment background
investigation. I acknowledge that if I provide false, inaccurate, incomplete or
misleading information it may result in my being terminated at a future
I also release ORNA its affiliates, subsidiaries, employees, trustees and agents
from any and all claims and liability related to or arising from my pre-employment
background investigation. I further release any and all parties providing
information in connection with my pre-employment background investigation from any
and all claims and liability related to or arising there from, and all such parties
are authorized to provide any information requested by ORNA in connection with the
pre-employment background investigation and to rely on this release as if they were
a party hereto.
I understand I may request access to the results of the criminal record checks
conducted in connection with this background investigation and that I will be given
an opportunity to address any findings that would negatively impact upon my being