APPLICANT’S CONSENT TO INVESTIGATIVE CONSUMER REPORT: I understand that due to the
nature of the jobs at Caring Smiles Family Dentistry, an investigative consumer report may be made
whereby information is obtained through interviews with various third parties. These inquires may
include information as to criminal, credit, driving record, character, general reputation, personal
characteristics and mode of living, whichever may be applicable. I understand I have the right to make a written request to Caring Smiles Family Dentistry, within a reasonable period of time for additional information concerning the nature and scope of any investigation conducted. I also acknowledge receipt of the previous statement regarding investigative consumer reports.