Name of Client: Client first name Client middle nameClient last name

Friends & Family Information:

Applicant First Name: Text field  Applicant Last Name: Text field   

Date of Birth: Date

Social Security Number: SSN 

Current Address: Text field   

Phone Number: Text field

Email: Text field

I, Text field (first name and last name), hereby authorize Living By Design Collective, LLC  to conduct a background check, which may include, but is not limited to, a review of my criminal history, employment history, credit history (if applicable), and other relevant records necessary to evaluate my qualifications for participation, employment, or engagement with Living By Design Collective, LLC.

Initials Text fieldI understand that the information obtained will be used solely for lawful purposes related to my involvement with Living By Design Collective, LLC.

Initials Text fieldI understand that I have the right to request a copy of any report obtained and dispute inaccurate information.

Initials Text fieldi understand that by completing this document, the named client above forfeits my spot on the "Family and Friends" list and will have one less person eligible to visit them.

DropdownI request a copy of the report obtained.

Disclosure Statement: Living By Design Collective ensures that all background check information is handled in compliance with applicable laws and kept confidential.

By signing below, I acknowledge that I have read and understood this consent form and voluntarily agree to the background check.

Signature: Signature

Today's Date: Date