I.C.U Exceed Authorization

I do hereby authorize verification of all information in my application from all sources of employment, education,
motor vehicle, financial history, personal history, person character, and workers compensation records in
accordance with ADA, labor and wage records, etc., or any part thereof, and authorize any duly authorized agent
to ICU Exceed to obtain, whether the said records are public or private and including those which may be deemed
as privileged or confidential in nature and I release all persons from liability on account of such disclosures,
information appearing on this authorization will be used exclusively by ICU Exceed for identification purposes and
for the release of information which will be considered in determining my suitability for hire. I certify that I have
made true, correct, and complete answers and statements on my application any supplements to it and in any
interview in the knowledge that they will be relied upon in considering my application. I agree to provide
additional information that may be requested to process my application. I authorize without reservation, any party
or agency contacted by ICU Exceed to furnish the above mentioned information. This authorization is valid during
the course of my tenure with ICU Exceed or to the extent the law permits.
I authorize ICU Exceed to obtain information pertinent to my previous employment by contacting previous (and
current, if applicable) employers in order to determine my eligibility for hire. I authorize previous employers to
release this information and hold them harmless from doing so. I also understand that ICU Exceed may need to
share this information with Customers for consideration for placement and authorize them to do so when
necessary.
I have the right to make a request to ICU Exceed, upon proper identification, to request the nature and substance
of all information in its files on me at the time of my request, including sources of information, and recipients of
any reports on me which ICU Exceed has.
I understand and agree that omission, false statement, misleading statement, or answer made by me on my
application or any supplements to it and in interviews will be sufficient grounds for termination.
Please sign below to acknowledge your understanding and agreement.