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Authorization for Background Check + Motor Vehicle Report

I authorize the Company and/or its agents to obtain information about me for the purpose of evaluating my eligibility to perform services as a Driver + Game Host independent contractor, including a consumer report and/or investigative consumer report, and a Motor Vehicle Report (MVR), as permitted by law. This may include verification of identity, addresses, employment history, criminal history (where allowed), and driving record. I understand that I may request the name and contact information of any reporting agency used, and I may have rights under applicable federal and state laws.

Contractor Information

Legal Name Other Names Used

Date of Birth

Phone Email

Current Address (Street)

Social Security #

Drivers license

Acknowledgment & Signature

I certify that the information provided is true and complete.

I acknowledge I may request a copy of any report obtained, to the extent permitted by law.

I understand this authorization may remain valid during my contractor engagement unless revoked in writing.

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Your legal name

Your email address

Please Confirm full name and signature.

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Timestamp

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December 1, 2025 1:57 pm EST

Authorization for Background Check + Motor Vehicle Report Uploaded by RALPH WALKER - info@c4mobilegaming.com IP 70.240.201.215