Facility Therapy Dog

Please make sure that all primary caregiver(s) and any other adult(s) with significant roles in the dog’s handling and care are present and able to review and complete the required signature of consent to check background history.

*Please note that consent is not required if a person is under 18 at time of application or if they will not be a primary dog handler.

I hereby authorize BluePath Service Dogs, Inc. and its designated agents and third party company representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for the purposes of a business and/or client relationship, including, but not limited to, employment, volunteer opportunities, or client/dog recipients. I understand that the scope of the consumer report/ investigative consumer report may include, but is not limited to, the following areas: criminal national database search (sex offenses, terrorist watchlist, FDA, GSA, OFAC, OIG); social security number; federal criminal national database; driving record; alias for all.

I further authorize any individual, company, firm, corporation, organization, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to BluePath Service Dogs, Inc, contracted third party agency, and any/all agents or representatives. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, organization, or public agency may have, to include information or data received from all sources.

I understand that I have the right to deny consent to the review of my background, and agree that BluePath Service Dogs, Inc. reserves the right to deny my application or terminate a partnership based solely on those grounds. I further agree, should I authorize BluePath Service Dogs, Inc. to review my background, the information provided from the data pertaining to me will be carefully reviewed, allowing BluePath Service Dogs, Inc. to take action of an appropriate nature, as they see fit, based on the findings from the consumer report, or investigative consumer report.

I understand that while BluePath Service Dogs, Inc. does not automatically terminate or disqualify business relationships, including employment, volunteering, or client /recipient, for past criminal activity, certain offenses may eliminate me from such partnership especially if the offense is related to the responsibilities of the role (e.g., violent crimes, sexual offenses, recent major driving violations). I further understand that factors, such as, the nature of the offense and its relation to the role, the time that has passed since the offense and evidence of rehabilitation will be considered.

I further authorize BluePath Service Dogs, Inc. to decide the appropriate course of action should a consumer report or investigative consumer report come back with unfavorable information. I understand that appropriate action could include, but is not limited to, termination of any/all relationships with the organization and its representatives, a new/different role within the organization, revoking driving privileges from organization vehicles or its professional property (including, but not limited to, service dogs and organization owned equipment), or an ineligibility for some or all future opportunities to partner with the organization, its affiliates, representatives, or individuals with a past partnership to the organization.

According to the fair credit reporting act (FCRA), I am entitled to know if the considerations for which I am applying are denied because of information obtained from a consumer-reporting agency. If so, I will be notified and be given the name of the agency providing the report. I will also be provided with the report itself; any actions taken because of the report, in writing; and a copy of the FCRA summary of rights for my review. I will be given an opportunity to formally, in writing, dispute any actions taken against me within 7 business days of notice for BluePath Service Dogs, Inc. review and reconsideration, with an understanding that there is no guarantee the organization will choose a new appropriate action.

By signing this document, I am providing BluePath Service Dogs, Inc. consent for an initial background check as well as any subsequent background checks deemed necessary, which can occur randomly and without warning, regardless of my current status (e.g. active or inactive) with the organization.