This form must be signed by a Notary and mailed or faxed to Starkey International.

In connection with my application for enrollment in the Starkey International Institute for Household Management, Inc. (SII), I understand that investigative background inquiries are to be made on myself including, but not limited to, personal interviews with my neighbors, friends, previous employers and acquaintances. Further, I understand that you will be requesting information from various Federal, State, and other agencies that maintain records concerning my past activities and may access information relating to my credit, criminal, driving, civil, worker’s compensation and other experiences. These reports may include information as to my character, general reputation, personal characteristics, reliability, and education (including school transcripts).
I authorize, without reservation, any party or agency contracted by SII to furnish the above-mentioned information. I hereby consent to your obtaining the above information from any licensed agents or services. I understand to aid in the proper identification of my files or records the following information is necessary.

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