Do e-signatures make the form legally valid?

Yes. Under the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states, electronic signatures are legally equivalent to handwritten signatures when intent, consent, attribution, and record retention are present.

Is a notarized form ever required?

Not usually for routine background checks, but some licensing boards or specific state rules may require notarization or in-person identification; check the receiving agency's requirements before submission.

What if the applicant disputes the report?

Follow FCRA dispute procedures if a consumer-reporting agency supplied the record. Retain the signed authorization and audit trail to support investigations and corrections.

Can you use a partial SSN instead of the full SSN?

Some vendors accept the last four digits to minimize exposure, but providing the full SSN improves match accuracy. Use the minimum data necessary for the intended search.

How should sensitive PII be stored?

Encrypt records at rest (AES-256) and in transit (TLS 1.2/1.3), restrict access, and follow applicable standards such as HIPAA, where relevant, and your internal retention policy.

How do I revoke consent after signing?

Revocation procedures should be described in the form. If revocation is permitted, stop future searches, notify vendors, and document the revocation; adverse-action timing and prior results may still be processed consistent with law.

Electronic Signature
Templates
Miscellaneous
Background Check Criminal Record Form

Background Check Criminal Record Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

BACKGROUND CHECK CRIMINAL RECORD FORM

WHEREAS

Requesting Company: and Applicant Name: desire to establish the terms under which the Requesting Company will obtain criminal record information about the Applicant for purposes of evaluation for employment, engagement, licensing, or placement.

WHEREAS, the Applicant consents to release of criminal history and related information by repositories, law enforcement agencies, courts, and other record holders to the Requesting Company and its authorized agents for the limited purposes described herein.

NOW, THEREFORE, Applicant and Requesting Company agree to the terms and authorizations set forth in this form.

APPLICANT INFORMATION

Full Legal Name

Date of Birth:

Social Security Number:

Current Address

Phone:

Email:

SCOPE OF BACKGROUND CHECK

The Requesting Company requests the following search activities. Applicant authorizes these inquiries and the release of responsive records.

Scope (select all that apply) County criminal record search Statewide criminal record search Federal criminal record search National sex offender registry search Driving record (where relevant) Other jurisdictions (list):

Detailed Scope Instructions

AUTHORIZATION AND RELEASE

The Applicant authorizes the release of any criminal history records, court dispositions, incarceration records, booking information, arrest records, and related identifying information to the Requesting Company and its designated agents for evaluation. Applicant releases all providers of such information from liability arising from release or use of the information in accordance with this authorization.

Applicant's Consent

By signing below the Applicant certifies that he/she has read and understands this Authorization and Release and expressly consents to the background investigation described herein.

CRIMINAL HISTORY DISCLOSURE

Have you ever been convicted of a felony or misdemeanor? Yes No

If yes, provide date, jurisdiction, offense and disposition

PAYMENT TERMS

The fee for the background check is agreed as follows.

Fee Amount (USD) Payment Schedule Late Fee / Interest for Overdue Payment

Responsibility for payment: Requesting Company Applicant

TERM AND TERMINATION

This authorization is effective on Start Date: and will expire on End Date: unless earlier revoked in writing. Either party may terminate this authorization upon written notice to the other party delivered at least days prior to the intended termination date.

CONFIDENTIALITY

All information obtained pursuant to this authorization will be used solely for the permitted purpose and will be treated as confidential by the Requesting Company and its agents. Disclosure is permitted only as required by law or with the Applicant’s further written consent. Records will be retained and disposed of in accordance with applicable legal requirements and the Requesting Company's record retention policies.

Confidentiality Exceptions (if any)

GOVERNING LAW

This Authorization and any dispute arising from it shall be governed by and construed in accordance with the laws of the State of without regard to that State's conflicts of law rules.

ENTIRE AGREEMENT

This form constitutes the entire agreement between the Requesting Company and Applicant concerning the subject matter hereof and supersedes any prior oral or written agreements or representations. Any amendment or modification must be in writing and signed by both parties.

CERTIFICATION

The Applicant certifies under penalty of perjury that the information provided in this form is true and complete to the best of Applicant’s knowledge. Applicant understands that false statements or material omissions may result in disqualification from consideration or termination of engagement.

Requesting Company:

By:

Title:

Date:

Applicant:

By:

Relationship to Applicant:

Date:

What the Background Check Criminal Record Form Is

The Background Check Criminal Record Form is a written authorization and data-collection document used to request a criminal history search from consumer-reporting agencies, government repositories, or law-enforcement databases. It records identifying data (full name, date of birth, aliases, addresses, and government identifiers), specifies the scope of the check, and captures the applicant's informed consent to obtain, use, and share criminal-history information for a permitted purpose such as employment, licensing, volunteering, or tenancy. Proper completion ensures compliance with applicable federal and state laws and supports defensible hiring or placement decisions.

Why a Clear, Compliant Form Matters

A properly drafted Background Check Criminal Record Form documents consent, limits scope, and creates an audit trail that helps satisfy FCRA requirements and state privacy laws. Accurate forms reduce legal exposure, speed processing, and improve accuracy when matching identities across databases.

Who Prepares and Signs These Forms

The person being screened must sign to demonstrate informed consent; organizations should retain copies and record the request details for dispute resolution and audit purposes.

Employers and HR teams conducting pre-employment screening for compliance and safety.
Landlords and property managers screening prospective tenants for suitability.
Licensing boards, volunteer coordinators, and contractor compliance personnel.

Essential Elements of a Professional Background Check Criminal Record Form

A complete form balances clarity and legal adequacy. It collects precise identifiers, explains the check's scope, discloses rights under the Fair Credit Reporting Act where applicable, and captures a dated signature and authentication method. The following components help you assemble a defensible record.

Identification

Full legal name, aliases, and date of birth to ensure accurate database matching and reduce false positives.

Government ID

SSN or partial SSN / TIN when permitted to improve match accuracy while limiting unnecessary exposure.

Scope of Search

Specify which repositories (national, state, county, sex-offender registry) and the date ranges covered by the search.

Purpose Statement

State the permissible purpose (e.g., employment, licensing) to meet user and reporter requirements.

FCRA Disclosure

Where consumer-reporting agencies are used, include required pre-adverse/adverse action disclosures and a clear consent section.

Signature & Date

Signed and dated consent, plus authentication method (e-sign link, notarization, ID check) and signer contact info.

Required Data Elements at a Glance

Full legal name: Exactly as on government ID

Date of birth: MM/DD/YYYY format

SSN or TIN: Full or last 4 digits, per policy

Known aliases: Maiden names, former names

Current and prior addresses: Street, city, state, ZIP

Signature and date: Signed, dated, and authenticated

Step-by-Step: Filling Out the Form

Complete the form carefully, verify identity, and confirm consent method before submitting to the screening vendor or agency.

01

Enter identifiers: Provide full name, DOB, and alias list
02

Provide addresses: List current and relevant prior addresses
03

Confirm purpose: Specify employment, licensing, tenant screening, etc.
04

Sign and date: Sign using the chosen method and add date

Customizing the Form for Online Workflows

Configure the form fields and authentication options to match your compliance needs before routing to a background-check provider.

Field	Configuration
Authentication Method	Email link, SMS code, or identity verification
Conditional Fields	Show SSN only when required; otherwise hide
Audit Trail	Capture timestamp, IP, and signer actions
Retention Flag	Mark for retention period per policy

Where to Send the Completed Form

After collecting consent and identity information, route the record to the chosen consumer-reporting agency, fingerprint vendor, or government repository according to the stated scope.

Internal HR: Upload to HRIS or applicant-tracking system
Background Vendor: Submit to CRA or fingerprint service
Licensing Agency: File with state licensing or regulatory board
Retention Archive: Store signed copy in secure records system

Distribution and eSubmission Options

Use platforms that support PDF/Word upload, mobile signing, audit trails, and integrations with HR or case-management systems to streamline processing.

Email + Attachment: Simple delivery; ensure TLS and encrypted storage for PII
Secure Link: Send a time-limited signing link with SMS or MFA
In-person or Notary: Use when statute or organizational policy requires notarization

Timing and Processing Expectations

Turnaround depends on search scope and data sources. Know typical deadlines to manage candidate communications and compliance steps.

Immediate checks:

National database queries often return within minutes to hours

County-level records:

May take 24–72 hours depending on clerk access

Fingerprint-based searches:

FBI returns often take several days to a few weeks

Adverse-action timing:

Allow time for pre-adverse notice and disputing procedures under FCRA

Record retention:

Store completed consent and results per retention policy

Common Mistakes to Avoid

Using incomplete identifiers (e.g., missing DOB or aliases) that produce mismatches and false positives.
Forgetting to include a clear purpose statement and FCRA disclosures when using consumer-reporting agencies.
Allowing unsigned or undated consent forms to be submitted, which can invalidate the authorization.
Sharing PII over unsecured email or storage without encryption, increasing breach risk and regulatory exposure.

Principal Legal Risks and Consequences

FCRA Liability: Civil damages and statutory penalties for improper use or failure to follow adverse-action rules

State Penalties: State consumer-protection fines and private-right claims vary by jurisdiction

Criminal Exposure: False statements or misuse of records may trigger criminal penalties in some states

Negligent Hiring: Civil claims if employer fails to follow reasonable screening practices

Data-breach Costs: Notification, mitigation, and regulatory fines if PII is exposed

Operational Delays: Incorrect forms lead to rework and longer fill times, affecting hiring timelines

Selected eSignature Vendor Comparison for This Form

Core vendor differences include starting price, trial availability, bulk-send capability, audit trail presence, HIPAA support, and any envelope caps that affect high-volume background-check workflows.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies	Varies	Varies

Real-World Examples of Usage

Organizations in multiple sectors standardize criminal-record authorizations to reduce manual work and improve candidate experience.

Optica Ventures LLC

Optica automated its consent forms and integrated vendor submission to reduce errors.

Streamlined identity capture and routing.
Brian Fitzgibbons, COO: "The interface is simple and easy-to-use for our team; more importantly, it is just as easy for our customers."

Martin Properties

A property management firm digitized tenant criminal checks to speed move-ins.

Reduced wait times for background results.
Tim Martin, Founder: "I can process and execute all of these documents online with 100% compliance and built-in security. Whether on mobile or working offline, I can get forms back to their necessary parties efficiently."

FAQs: Common Questions About the Form

Answers to typical questions about consent, e-signatures, disputes, and record handling when using a Background Check Criminal Record Form.

Need help? Contact support

Do e-signatures make the form legally valid?
Yes. Under the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states, electronic signatures are legally equivalent to handwritten signatures when intent, consent, attribution, and record retention are present.
Is a notarized form ever required?
Not usually for routine background checks, but some licensing boards or specific state rules may require notarization or in-person identification; check the receiving agency's requirements before submission.
What if the applicant disputes the report?
Follow FCRA dispute procedures if a consumer-reporting agency supplied the record. Retain the signed authorization and audit trail to support investigations and corrections.
Can you use a partial SSN instead of the full SSN?
Some vendors accept the last four digits to minimize exposure, but providing the full SSN improves match accuracy. Use the minimum data necessary for the intended search.
How should sensitive PII be stored?
Encrypt records at rest (AES-256) and in transit (TLS 1.2/1.3), restrict access, and follow applicable standards such as HIPAA, where relevant, and your internal retention policy.
How do I revoke consent after signing?
Revocation procedures should be described in the form. If revocation is permitted, stop future searches, notify vendors, and document the revocation; adverse-action timing and prior results may still be processed consistent with law.

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now