Scribd
Upload
159 views1 page

(Z) Consent Letter

The document is an authorization form for an individual to release background check information for employment purposes. It authorizes the company and its agents to conduct a comprehensive background review, including criminal history, financial checks, education and employment verification. The individual provides consent to release this information and waives liability for the company. The form also collects the individual's personal details such as name, ID number, date of birth, address and contact information. It requests for previous employment references that may be contacted for reference checks.

Uploaded by

Zariq Aziz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
159 views1 page

(Z) Consent Letter

The document is an authorization form for an individual to release background check information for employment purposes. It authorizes the company and its agents to conduct a comprehensive background review, including criminal history, financial checks, education and employment verification. The individual provides consent to release this information and waives liability for the company. The form also collects the individual's personal details such as name, ID number, date of birth, address and contact information. It requests for previous employment references that may be contacted for reference checks.

Uploaded by

Zariq Aziz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

AUTHORIZATION FOR RELEASE OF INFORMATION FOR EMPLOYMENT PURPOSES

Background Screening Disclosure


I hereby authorize TIME dotCom Berhad and its designated agent, Verity Intelligence Sdn Bhd and representatives to conduct a
comprehensive review of my background through a consumer report and/or a background check report to be generated for
employment, promotion, reassignment or retention as an employee. I understand that the scope of the report/background check
report may include, but is not limited to, the following areas: names and dates of previous/current employment, work experience,
workers compensation/claims, criminal history records (from local, state, federal, international and other law enforcement
agencies’ records), wants and warrants records, motor vehicle records, educational verification, license verification, business
interest and directorship, financial checks with Credit Reporting Agencies and Bank Negara Malaysia Central Credit Reference
Information System or CCRIS record, civil cases, any sanction lists, and drug testing.

Authorization and Release


Mohamad Norzariq Bin Mhd Aziz
I,__________________________________________, authorize the complete release of these records or data pertaining to me
which an individual, company, firm, corporation, or public agency may have. I authorize the full release of the information
described above, without any reservation. I hereby release TIME dotCom Berhad and its agent Verity Intelligence Sdn Bhd,
officials, representatives, or assigned agencies, including officers, employees, or related personnel both individually and
collectively, from any and all liability for damages of whatever kind, which may at any time, result to me, my heirs, family or
associates because of compliance with this authorization for release form. I certify that all information provided below and on my
resume is correct to the best of my knowledge. Any false statements provided in this form and my resume will be considered just
cause for the termination of employment at any time. This authorization and consent shall be valid in original, fax, or copy form.

The following information is required by law enforcement agencies and other entities for identification purposes when checking
records. It is confidential and will not be used for any other purpose.

Mohamad Norzariq Bin Mhd Aziz


Applicant’s Name: ________________________________________ 019 6182116
(______)____________________ Mobile Phone

940303017097
NRIC /Passport Number:_______________________________ 03 03
______/________/19______ 94 (Month/Day/Year)
Date of Birth (This will not affect hiring decision)

B-9-12, Vista Lavender Apartment, Taman Kinrara, Seksyen 3, 47100 Puchong


Current Address: ___________________________________________________________________________________________

_________________________________________________________________________________________________________

____________________________
Applicant’s Signature
Date: 11/3/2021

PREVIOUS COMPANY REFEREE INFORMATION (please make sure you have informed your Referees below on your job application)

Referee #1: Ex-Supervisor Referee #2: Ex-Supervisor Referee #3: HR Personnel/Peer


Name: Nor Hazura Ninggal Name: Norijah binti Selar Name:
Designation: Operation Manager Accenture Designation: Manager Designation:
Company Name: Accenture Technology Solutions Company Name: Yakin Diri Enterprise Company Name:
Tel No: 0192215264 Tel No: 0197752342 Tel No:
Email Address: [email protected] Email Address: Email Address:

Have you been convicted of or pleaded no contest to a felony/crime?


Yes_____ No_____ If yes, please explain: _________________________________________

Can We Contact Your Current Employer? Yes _____ No _____ (If Yes, we will call you for a verbal confirmation before proceeding)

Important Note:
We will be contacting both the HR Department (of your previous companies) and the ex-supervisor as provided
by HR for an assessment/reference check. If you have any concerns, kindly raise this for discussion during the
interview.

You might also like