El Huevo Saltarin

Client and Applicant Instructions Puerto Rico For background reports in Puerto Rico, the applicant will have to follow the instructions below: 1. Please read, complete and sign theSpecial Letter of Authority (form attached).

Please scan and email the required documents to: InternationalForms@verificationsinc.com Or Fax Documents to: 605-884-1310 Please be awarethat international background checks often take longer than checks done in the United States.

Verifications Inc.

Tel: +1 605 884 1200 Fax: +1 605 884 1140PuertoRico-AplInstr-2012-05-29.docx29

1425 Mickelson Drive Watertown, SD 57201

SPECIAL LETTER OF AUTHORITY I hereby request and authorize Verifications Inc., its employees and its agents, to obtain acopy of my academic, employment, driving, and criminal history records in Puerto Rico. This document has been requested by my prospective employer regarding my job application with:Employer

Location

The information is only to be used for the job application and CANNOT be used for any other purpose. I certify that I am the person identified in thisauthorization. Sincerely,
Applicant’s Signature Applicant’s Printed Name

Date

My personal details are:

First Name & Middle Name Maiden Name Social Security Number Date of birth Place ofbirth

Last Name

(day / month/ year)

Sex (M/F)

Father’s Name

Mother’s Maiden Name

Driver’s License Number

Address Applicant’s last address in Puerto Rico (Post officeboxes are not acceptable):
Street Address City/State Postal Code

Dates Applicant last resided in Puerto Rico during this time:
Dates of Residence
(day/month/year) to

Dates ofResidence

(day/month/year)

Verifications Inc.

Tel: +1 605 884 1200 Fax: +1 605 884 1140 PuertoRico-CD-LOA-2012-05-29.doc29

1425 Mickelson Drive Watertown, SD 57201