Application Form

Facis Level 3 Notice and Authorization

Dear Healthcare professional:

 

As part of Loyalty Staffing Solutions’ registration process prior to considering your services, a FACIS level 3 background check is required. In order to procure the background check, you are required to provide us with your social security number.

 

By your signature below, you hereby authorize Loyalty Staffing Solutions to obtain the report. You acknowledge that the information contained in this report is derived from governmental and administrative agencies.

 

Additionally, by signing this document you understand and agree to allow Loyalty Staffing Solutions to release this information to client facilities that may have nee of your services.

 

I hereby authorize the company, without reservation, to provide the consent and authorization to the People Facts 1435 Chesterfield Lane Maumee, OH 43537 (#800-662-0130) or other organization to conduct the search.

Your Signature

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T: +1 (844) 991-9897  A:1810 Carriage Lane, Palm Springs, California. 92262