Employment Disclosure and Release

I hereby authorize Premier Heating and Cooling, its employees, agents, private investigators or any representative of the aforesaid company, to perform investigations into my background, past behavior, to my character, general reputation, and mode of living including but not limited to these.


I understand that the information gained from this investigation, in whole or in part, may be used to determine my suitability for employment with Company. I understand that I may be asked to complete a psychological profile. I understand that I may be asked to complete a skill, logic, or other test. I further understand that the results of which, whether in whole or in part, may be used to determine my suitability for employment with Company.

Investigative Consumer Reports

I authorize the Company to perform investigative consumer reports that may include credit reports, criminal history or arrest records, workers’ compensation histories, motor vehicle records, employment and unemployment records, military records, or other sources of information.

Education and Employment

I authorize schools, colleges and all scholastic institutions to release any and all information requested. This includes transcripts, grades, attendance records, and any other information requested. I authorize all former and current employers to release any and all information regarding my employment history. This includes all information contained in my personnel file, salary history, condemnations, and all other pertinent information. I further authorize my supervisors and other work associates to disclose their opinions and observations of my work habits, qualities, competency, and skills. Furthermore, I authorize full disclosure of any and all drug and alcohol testing results.

Authorization and Understanding

I authorize custodians of the records of any agency, government agency, or company as described above to release such information upon request of any investigator, agent, or representative of the Company. I understand that any or all of these investigations or inquiries can be performed prior to and periodically throughout the duration of my employment. I understand that the information requested is for the use by the Company and may be re-disclosed only as authorized by law.

Release and Indemnification

I indemnify, release, and hold harmless the Company, any agents of the Company, or others reporting to or for the Company, any investigators, all former employers, supervisors, managers, coworkers, reporting agencies, and all those supplying references and character references, from any and all claims, defamation, demands, damages, losses and expenses, and/or liabilities arising out of, or related to, such investigations, disclosures, or admissions including reasonable attorney’s fees arising out of or by reason of complying with this request

Waiver of Certain Rights

I understand my rights under Title 5. United States Code, Section 552a, the Privacy Act of 1974, with regard to access and disclosure of records, and I waive those rights with the understanding that information furnished will be used by Company in conjunction with employment procedures.


I specifically understand that it is necessary for me to release my date of birth and I hereby agree to release my date of birth for the purposes of performing this investigation. I agree to allow Company to provide a copy of this agreement to any other entity who provides information to Company about me. I understand that should information of a serious criminal nature surface as a result of this investigation, such information may be turned over to the proper authorities. I agree that a photocopy or FAX copy of this release form will be valid, as an original thereof, even though the said photocopy or FAX copy does not contain an original writing of my signature.


This waiver, in the original or copy form, is valid and will apply throughout my employment, to the extent permitted by law, unless I revoke or cancel my consent by sending a signed letter or statement to the company at any time.