*Organization Name: (Hereinafter referred to as Client Organization).	Doing Business As (DBA):
*First Name:	*Last Name:
*Phone #:	*Email:
*Physical Address:
Unit #    Street         City      Province    Postal Code
Preferred Language: English   French	*Approximate Number of Yearly Checks:
*Are you affiliated with OESC? Yes No	*Are you a TELUS Dealer?  Yes No

myBackCheck.com will provide one or more of the following services to Client Company for employment related purposes:

Criminal History Checks, Online ID Verification, eReference Interviews

myBackCheck.com certifies and agrees to provide the above services to Client Organization in a manner that is legal and compliant with all applicable laws. myBackCheck.com will provide services according to pricing and turnaround guidelines established on www.myBackCheck.com.

myBackCheck.com will keep copies of any release forms, consent forms, and written reports on file either in electronic or printed format. All such information is kept in a secure location only accessible to authorized myBackCheck.com personnel. myBackCheck.com will keep all information regarding users of myBackCheck.com on file either electronically or in printed format for seven years.

myBackCheck.com certifies that all myBackCheck.com employees have been appropriately screened prior to employment. All information gathered by myBackCheck.com employees is kept strictly confidential according to PIPEDA or equivalent provincial privacy laws.

Neither party shall be liable in damages because of delay or default in performing hereunder if such delay or default is caused by conditions beyond its control including, but not limited to Acts of God (including fire, flood, earthquake, storm, hurricane or other natural disaster or unusual weather), interruption or failure of electricity or internet service. Moreover including without limitation, failure of suppliers, subcontractors, carriers, or other party to substantially meet its performance obligations under this Agreement, provided that as a condition to the claim of no liability, the party experiencing the difficulty shall give the other prompt written notice with full details following the occurrence of the cause relied upon and/or any other cause beyond the reasonable control of the parties whose performance is affected.

Client Organization acknowledges and agrees that background information is derived from databases and records that have been created and maintained by various government agencies, private companies, and other human contributors that are not under the control of myBackCheck.com. Client Organization acknowledges that while myBackCheck.com will exercise due diligence in delivering the highest quality of background checks, myBackCheck.com cannot guarantee the accuracy or completeness of background checks due to the fallibility of such sources, both human and otherwise.

For Criminal History Checks, myBackCheck.com will deliver results within one (1) business day upon a request being submitted in its entirety. 

In connection with requests for myBackCheck.com services, the undersigned, who is a duly authorized representative of Client Organization, agrees to the following terms of service and privacy of information requirements:

1. Client Organization agrees that it will not use any information regarding myBackCheck.com and its business to compete in any way with myBackCheck.com.

2. Client Organization agrees to keep information provided by myBackCheck.com in a secure location that is non-accessible to unauthorized personnel.

3. Client Organization agrees to use information provided by myBackCheck.com in a manner that complies with all related federal and provincial legislation.

4. Client Organization agrees to comply with myBackCheck.com’s Identification requirements for conducting criminal history checks where online ID verification cannot proceed, namely one (1) piece of Government issued ID will be verified and certified by Client Organization, photocopied and faxed or emailed along with the accompanying consent form(s) to myBackCheck.com, and copies of such to be retained along with original signed consent forms for a minimum period of one (1) year.

5. Client Organization certifies that any destruction of documents will be done in a manner that renders them completely destroyed and unusable, via cross shredding or a certified document destruction company.

6. For Criminal History Checks, information not search for includes: convictions not yet entered, outstanding charges, indices checks with the police services in the jurisdiction in which the candidate resides, charges dealt with by way of alternative measures or other non-judicial sanctions, convictions relating to summary conviction offences and offences relating to provincial statutes.

*Please choose one of the following options:
Option 1: Pay by Credit Card - A myBackCheck.com representative will contact you to collect your credit card number by phone.         Will you require a copy of your invoice? Yes  No
Option 2: Applicant Paid If you have additional requirements or queries, please refer to the Additional Comments/Instructions section at the bottom of this form.
Additional Payment Terms
Please Note: By registering your organization with myBackCheck.com, you allow individuals to share their results with you.  There are no fees for membership or obligations to purchase anything.  You will only be charged if you purchase services.
Is your organization GST exempt? Yes  No	If yes please provide us with your tax exemption number:
Does your organization require purchase orders? Yes  No	Send Invoice By: E-mail  Mail