HireRight agreement

[http://dummy.us.eu.org/robert (Robert)]

Robert http://dummy.us.eu.org/robert

Signature Confirmation

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TO: http://dummy.us.eu.org/robert
CC:

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upon request. A copy of the document may be obtained for a $15.00 service
fee by contacting HireRight Customer Service at
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DISCLOSURE, AUTHORIZATION AND RELEASE FOR OBTAINING BACKGROUND INFORMATION

For additional information, refer to: A Summary of Your Rights Under the
FCRA and A Summary of CA Civil Code, section 1786.22 (CA residents only)

DISCLOSURE, AUTHORIZATION AND RELEASE FOR OBTAINING BACKGROUND
INFORMATION I understand that in connection with my employment with xxxx
Inc. ("xxxx") , will request an outside agency, HireRight
whose principal address is 2100 Main Street, Suite 400, Irvine, CA 92614
to research and verify the information I have provided on my personal
background. I further understand that xxxx's HR outsourcing services
provider Hewitt Associates, Inc. may have access to aforementioned
information. I understand that HireRight will obtain information it
deems appropriate from various sources including, but not limited to the
following: court records, credit reports, and Department of Motor
Vehicle records and medical records. I understand that within a
reasonable period of time I may request in writing that, xxxx further
disclose the nature and scope of the investigative report requested by
it, and I may request in person or in writing that HireRight make a copy
of files maintained on me available for my inspection. I hereby
authorize xxxx and Hewitt to obtain and review reports from HireRight as
described above. I also hereby authorize, without reservation, any
individual, corporation or other private or public entity to furnish
xxxx and HireRight all information about me. I unconditionally release
and hold harmless any individual, corporation, or private or public
entity from any and all causes of action that might arise from
furnishing to xxxx and HireRight information that they may request
pursuant to this release. This authorization and release, in original,
faxed or photocopied form, shall be valid for this and any future
reports and updates that may be requested by xxxx or Hewitt.

, Robert

Social Security Number or Personal ID:
Date of Birth (for ID purposes only): Not Provided
Phone Number: my-Oakland-voicemail-number
Current Address: where-I-live

US xxxx Inc. Your contact person: HireRight Service Center
Phone: (949) 428-5846

I have read this agreement and accept all the terms described
herein. _X_

Electronic Signature Signed: 
Dated: 06 22, 2005: 21:23 Pacific Standard Time

This is an electronic signature, and is given in accordance to U.S.
federal regulations governing the legal and binding effectiveness of
electronic signatures.