Candidate Information Release

I, the undersigned, authorize Rein Worldwide, Inc. to compile a consumer credit

report/investigative report on me, at any time prior to or during my employment with
Rein Worldwide, Inc. or its subsidiary companies.

I also authorize any person, business entity or governmental agency, including,

but not limited to, any courthouses, public agencies, law enforcement agencies, credit
bureaus, employers and educational institutions having any relevant information, to
disclose the same to Rien or its designated representatives, agents or employees,
regardless of whether such person, business entity or governmental agency gathered the
information itself or received it from other sources.

These reports may include, but are not limited to, employment and education
verifications; personal and professional references; personal credit history based on a
report from any credit bureau; driving history, including traffic citations; Social Security
number verification; present and former addresses; criminal and civil records; and any
other public record.

I hereby release and hold harmless Rein Worldwide, Inc., its designated
representatives, agents or employees, and any and all persons, business entities and
governmental agencies, public or private, from all liability, claims and/or demands of
whatever kind for obtaining, selling, providing, brokering and/or assisting with the
collection or preparation of the consumer/investigative report authorized herein.

Name (Please print)_______________________________ Gender:______

First Middle Last

Current Residence:______________________________

City:_______________ State: ____ Zip: _________

Telephone Number: __________ Email: ___________________

Previous Residence(s):_____________________

_______________________________________________________________________
_

Social Security Number:________________________________________

Driver’s License Number:____________ State:_________

Date of Birth:_____________________
Signature:_____________________ Date____________