CourierRFC4 – Data Rush

I certify that all information furnished by me is true and correct and that I will conceal no information that may be relevant to my request for contracting. I authorize Data Rush to make investigations and inquiries of my personal, employment, financial and/or driver’s license history and other related matters, as Data Rush deems necessary for arriving at a contractual decision. I authorize my former employers, schools and references to give Data Rush any information they may have regarding me that may be requested by Data Rush and I hereby release them from any and all liability for issuing such information(required)

Yes

No

I understand that I will be subject to termination as an agent at any time if anything on this request to contract is found to be false and/or misleading.(required)

Yes

No

In connection with my application for contracted service with Data Rush., I understand that consumer reports which may contain public record information may be requested from DAC services, Tulsa, Oklahoma . These reports may include the following types of information: names and dates of previous employer(s), reason for termination of employment, work experience, accidents, etc. I further understand that such reports may contain public record information concerning my driving record, workers compensation claims, credit, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records, as well as information from DAC concerning previous driving record requests made by others from such state agencies, and state provided driving records.(required)

Yes

No

I authorize, without reservation, any party or agency contacted by DAC to furnish the above-mentioned information.(required)

Yes

No

I have the right to make a request to DAC upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the recipients of any reports on me which DAC has previously furnished within the two-year period preceding my request. I hereby consent to your obtaining the above information from DAC, and agree that such information which DAC has or obtains and my contracted services with Data Rush. will be supplied by DAC to other companies which subscribe to DAC services.(required)

Yes

No

I hereby authorize procurement of consumer report(s). If contracted, this authorization shall remain on file and shall serve ongoing authorization for you to procure consumer reports at any time during my contract period.(required)

Yes

No

My Name(required)

now, some legal stuff

Statement of Contractor, Disclosure and Release

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