Background Check

To apply, please fill out our application, background check, and references forms

1) Application

2) Background Check

3) References

Background Check

Consent and Confirmation*
I hereby authorize Lirio Resources (formerly CDC Resources, Inc.) to request and obtain Criminal History Records, Motors Vehicle Records (MVR), Nurse Aid Registry, and OIG checks as a condition of my employment. I further authorize the State and County Police to release information relative to the existence or non-existence of any criminal record which it may have concerning me to the requestor solely to determine my suitability for employment or continued employment.

I further authorize any agency which maintains records relating to me to provide the same upon request. I certify that the State Police and any agency who furnish this information shall be held harmless from any and all liability which may be incurred as a result of releasing such information. I further acknowledge that CDC Resources, Inc. shall not be liable for the failure to hire or retain an applicant or employee who has been convicted of committing or attempting to commit a crime that has not been expunged.

I understand that the information requested below regarding date of birth, gender, race/ethnicity is for the sole purpose of identification and the gathering of the above-mentioned information about me accurately and that it will not be used to discriminate against me in violation of the law. I understand that the provision of the social security number is required by law. A facsimile or photographic copy of this authorization will also be valid as the original.
I declare that all information provided on this document is true and accurate.
Signature*
Date*
MM slash DD slash YYYY
Name*
First Last
Other Names Used and/or Maiden Name
First Last
Email*
Date of Birth*
MM slash DD slash YYYY
Social Security Number
Gender
- Male
- Female
- Non-binary
Race/Ehnicity
Drivers License Number
State Issued
Expiration Date
MM slash DD slash YYYY
Address
Street Address City State ZIP Code
Previous Address
Previous Mailing Address if changed in the last 5 years.

Street Address City State ZIP Code

To apply, please fill out our application, background check, and references forms.

1) Application

2) Background Check

3) References

Background Check

Background Check

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