APPLICATION FORM Overseas Criminal Record Check MEXICO Mexico Overseas Criminal Record Check Application Form Guidance Notes This application form captures the data required by GB Group Plc, in order to process an overseas criminal check in Mexico. Before you start, please read all the information below to help ensure you complete this simple form, accurately. Information Required: Please ensure all fields are complete and the full application has been completed by the applicant. Information required includes: o Your personal details, such as full name and date of birth o Your current address and previous address history for the past 10 years o Your Mexican ID Number o Signed consent form Please follow these steps and complete the following application form. To confirm you give your consent – please ensure you sign and date the Release of Information form attached in Section 4 of the application form. Without your signature and date as proof of consent the application cannot be processed Registered Office: GB Group plc. Registered in England 2415211. VAT Number 539 7162 18 The Foundation, Herons Way, Chester Business Park, Chester, CH4 9GB © GB Group plc| KnowYourPeople Page 1 of 5 Mexico KnowYourPeople Application Form The Application Form This form can either be completed electronically or printed out and filled in with black or blue ink. You must ensure to provide a wet signature in order to give your consent. Section 1 – Personal Full Name: (First, middle, last) Date of Birth: DD/MM/YYYY Section 2 – Address Details Please supply your current address and previous address history for the past 10 years. It is important that you do not leave any gaps between addresses. Your application cannot be processed without this information. Current Address Building Name: House/Flat Number: Street: City/Town: Postcode/Zip code: Country: Date of Residence from: MM/YYYY Registered Office: GB Group plc. Registered in England 2415211. VAT Number 539 7162 18 The Foundation, Herons Way, Chester Business Park, Chester, CH4 9GB © GB Group plc| KnowYourPeople Page 2 of 5 Until: MM/YYYY Mexico Previous Address # 1 Building Name: House/Flat Number: Street: City/Town: Postcode/Zip code: Country: Date of Residence from: MM/YYYY Until: MM/YYYY Previous Address # 2 Building Name: House/Flat Number: Street: City/Town: Postcode/Zip code: Country: Date of Residence from: MM/YYYY Until: MM/YYYY Previous Address # 3 Building Name: House/Flat Number: Street: City/Town: Postcode/Zip code: Country: Date of Residence from: MM/YYYY Registered Office: GB Group plc. Registered in England 2415211. VAT Number 539 7162 18 The Foundation, Herons Way, Chester Business Park, Chester, CH4 9GB © GB Group plc| KnowYourPeople Page 3 of 5 Until: MM/YYYY Mexico Previous Address # 4 Building Name: House/Flat Number: Street: City/Town: Postcode/Zip code: Country: Date of Residence from: MM/YYYY Until: MM/YYYY Previous Address # 5 Building Name: House/Flat Number: Street: City/Town: Postcode/Zip code: Country: Date of Residence from: MM/YYYY Until: MM/YYYY Previous Address # 6 Building Name: House/Flat Number: Street: City/Town: Postcode/Zip code: Country: Date of Residence from: MM/YYYY Until: MM/YYYY * If more space is required to provide your full 10 year address history, please use a blank piece of paper and send, or scan this together with the signed application form. Registered Office: GB Group plc. Registered in England 2415211. VAT Number 539 7162 18 The Foundation, Herons Way, Chester Business Park, Chester, CH4 9GB © GB Group plc| KnowYourPeople Page 4 of 5 Mexico Section 3 – Identification Details to support the application Please provide ALL details of any documents you possess. Mexican ID Number: Section 4 – Applicant/Employee Notification / Release of Information The purpose of this form is to explicitly inform you and to obtain your prescribed consent to release to GBG and RISQ Group, incorporating AIM Screening, (“the Group”), agents of our company, the personal information provided by you to our Company or information about you collected and compiled by our company (the “Information”) in the course of or in relation to the application for this Check. The Information will be released to “the Group” and/or its agents to conduct searches on your background information, which may include civil and criminal records, local language media information, as requested by our company (the “Collected Information”). You hereby authorize our company through “the Group” and/or its agents, as well as “the Group” explicitly, to contact various government agencies and courts and other contributors (the “Contributors”) as a relevant party acting on your behalf for the purposes of obtaining the Collected Information. This letter releases the Contributors from any liability and responsibility for releasing the Collected Information to our Company or “the Group”. “The Group” and/its agent may release the Information and this consent letter to the Contributors and such other persons as may necessary for the purposes of performing such searches. “The Group” will furnish to the customer a report containing the Collected Information (the “Report”). The Report shall be the property of our company. Any request for a copy of the Report or details of the Collected Information contained therein shall be made to “the Group” in the first 60 days after signing this letter or after that period, directly to our company in writing. In signing this letter, you confirm that your consent is given voluntarily and shall remain valid and effective until and unless it is withdrawn by you with prior written notice. We acknowledge that “the Group” (and its agents) in collecting, holding, processing and using the Information, the Collected Information and such other related information and documents that may contain your personal data solely on behalf of us and does not hold, process or use this information for any of its own purposes. Release of Information I confirm that I have read the above Statement of Applicant/Employee Notification / Release of Information and give my consent by providing wet signature: Print Name: Applicant Signature: Date: PLEASE RETURN THIS FULLY COMPLETED APPLICATION FORM BACK TO YOUR EMPLOYER Registered Office: GB Group plc. Registered in England 2415211. VAT Number 539 7162 18 The Foundation, Herons Way, Chester Business Park, Chester, CH4 9GB © GB Group plc| KnowYourPeople Page 5 of 5
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