Disclosure and Authorization Pertaining to Consumer Reports Pursuant to the Fair Credit Reporting Act

This is a release for Barron Service Parts Co. (BSP) to obtain one or more consumer/credit reports about you in connection with your application for employment or in the course of your employment with BSP. One or more reports about you may be for employment purposes, including evaluating your fitness for employment, promotion, reassignment or retention. The results will be provided to BSP.

I, _______________________________________________, hereby authorize BSP and/or its agents to make an independent investigation of my background, references, character, past employment, education, credit history, criminal or police records, and driving records, including those records maintained by both public and private organizations and all public records for the purpose of confirming the information contained in my application for employment and/or obtaining other information which may be material to my qualifications for employment now and, if applicable, during the tenure of my employment with BSP. I understand and acknowledge that my failure to disclose the fact of any criminal conviction(s) which became final prior to or which become final during any term of employment with BSP is subject to discipline, up to and including termination. I also acknowledge receipt of the document titled “Summary of Your Rights under the Fair Credit Reporting Act.”

I release BSP and/or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the information obtained from any and all of the above referenced sources used.

The following is my true and complete legal name and all information contained herein is true and correct to the best of my knowledge: