Background Check Authorization
Obtains an applicant’s informed authorization for pre-employment background screening, capturing legal identification details, current and previous addresses, relevant driving credentials, disclosure acknowledgments, report-copy preferences, and signed consent.
Related topics
- Address History
- Applicant Authorization
- Applicant Consent
- Applicant Rights
- Background Check Authorization
- Background Check Form
- Background Report Copy
- Background Verification
- Candidate Verification
- Consumer Reporting Agency
- Criminal Record Check
- Digital Signature
- Disclosure Statement
- Driver’s License Verification
- Driving Record Check
- Education Verification
- Employment Authorization
- Employment History Verification
- Employment Screening
- Fair Credit Reporting Act
- FCRA Compliance
- Hiring Compliance
- Hiring Process
- Human Resources
- Identity Verification
- Investigative Consumer Report
- Legal Name Verification
- National ID
- Personnel Screening
- Pre-Employment Screening
- Previous Names
- Recruitment Documentation
- Seven-Year Address History
- Social Security Number
Background Check Authorization
Part 1: Clear Disclosure (Must be on a Separate Page)
The Disclosure Statement
The Company ("the Company") may obtain a consumer report and/or an investigative consumer report about you for employment purposes. These purposes may include hiring, retention, reassignment, or promotion. This background check may look into your personal and professional history to evaluate your suitability for the position.
The investigation may include, but is not limited to, a review of your criminal record, verification of past employment, educational history, driving record (motor vehicle reports), and professional licensing or certifications.
These reports will be obtained from a consumer reporting agency. You have the right, upon written request made within a reasonable time, to request whether a report has been run and to receive a disclosure of the nature and scope of the investigation.
The investigation may include, but is not limited to, a review of your criminal record, verification of past employment, educational history, driving record (motor vehicle reports), and professional licensing or certifications.
These reports will be obtained from a consumer reporting agency. You have the right, upon written request made within a reasonable time, to request whether a report has been run and to receive a disclosure of the nature and scope of the investigation.
Part 2: Applicant Information
Full Legal Name
First name, middle name, and last name (printed clearly).
Type your response here...
Other Names Used
Any maiden names, nicknames, or aliases used in the past.
Type your response here...
Date of Birth
Social Security Number (SSN) or National ID
Type your response here...
Driver’s License Number
Type your response here...
State/Province of Issue
Type your response here...
Current Physical Address
Address Line 1
Not provided
Address Line 2 (Optional)
Optional
City
Not provided
State / Province
Not provided
ZIP / Postal Code
Not provided
Country
Not provided
Contact Number
Not provided
Past Address I
Address Line 1
Not provided
Address Line 2 (Optional)
Optional
City
Not provided
State / Province
Not provided
ZIP / Postal Code
Not provided
Country
Not provided
Contact Number
Not provided
Past Address II
Address Line 1
Not provided
Address Line 2 (Optional)
Optional
City
Not provided
State / Province
Not provided
ZIP / Postal Code
Not provided
Country
Not provided
Contact Number
Not provided
Past Address III
Address Line 1
Not provided
Address Line 2 (Optional)
Optional
City
Not provided
State / Province
Not provided
ZIP / Postal Code
Not provided
Country
Not provided
Contact Number
Not provided
Part 3: State-Specific Checkboxes (If Applicable)
Copy of the Report
Check here if you live in certain states (like California, Minnesota, or Oklahoma) and want a free copy of the background report sent directly to you.
Part 4: Authorization & Signature
Consent Statement
I hereby authorize the company to conduct a background check and obtain an investigative consumer report as described above
Acceptance required
Applicant Signature
Full Name (Printed) *
Expired on
Valid Till Date
Draw Signature *
Sign within this boundary
Confirm Signature
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