Can this form be signed electronically?

Yes. Electronic signatures satisfy legal requirements under the ESIGN Act (15 U.S.C. §7001) and state UETA laws where adopted when intent, consent, attribution, and retention are demonstrated. Exceptions include wills and some court filings that state law excludes from e-signature treatment.

Is notarization required for the declaration?

Not typically required for most Background Information Declarations. Specific uses, such as sworn affidavits or certain licensing applications, may require notarization. Requirements vary by state and agency; confirm with the requesting authority or notary commission before assuming notarization is unnecessary.

How should sealed or expunged records be handled?

Follow the form's instructions and applicable state law. Some jurisdictions prohibit disclosure of sealed or expunged records, while others permit limited disclosure to licensing authorities. Consult state statutes or legal counsel before including expunged records to avoid improper disclosure.

What proof is needed for identity verification?

Provide government-issued photo ID, any additional documents listed on the form, and accurate personal identifiers (full legal name, DOB, current address). High-risk cases may require stronger authentication such as knowledge-based verification or ID credential analysis.

Can a submitted declaration be revoked or amended?

Revocation or amendment depends on context. You can typically submit an updated declaration or written correction, but decisions made based on the original may remain effective. For regulatory matters, follow the requesting agency's procedures for amendments or retractions.

How long must signed declarations be kept?

Retain signed Background Information Declarations according to applicable rules: generally at least three years for tax-related records (IRC §6501(a)), six years for HIPAA-covered records (45 CFR §164.530(j)), and longer if state law or industry rules require extended retention.

Electronic Signature
Templates
Miscellaneous
Background Information Declaration

Background Information Declaration

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

Background Information Declaration and Agreement

THIS BACKGROUND INFORMATION DECLARATION AND AGREEMENT (the Agreement) is entered into by and between Declarant Name: and Requesting Party Name: .

WHEREAS

WHEREAS, the Requesting Party has requested certain background, credential and related information from Declarant in connection with the provision of services described in this Agreement; and

WHEREAS, Declarant is willing to provide accurate disclosures and authorizations for background inquiries and to enter into a limited business agreement governing confidentiality, payment and other terms set forth below.

WHEREAS, the parties intend for the disclosures and representations made herein to form part of the contractual basis for the parties' relationship and to be relied upon by the Requesting Party.

DECLARANT INFORMATION

Full Legal Name Current Address

Date of Birth: Identification (last 4 digits if applicable):

SCOPE OF WORK

Description of Services or Engagement (Scope of Work)

BACKGROUND DISCLOSURES

Criminal Convictions or Pleas: Check if there are convictions, pleas or deferred adjudications to disclose.

If checked, provide details (dates, jurisdiction, disposition)

Pending Criminal Charges: Check if there are pending criminal charges.

Civil Litigation or Claims Against Declarant:

If checked, provide a brief description of matter(s)

Bankruptcy Filing in Last Ten Years:

If checked, provide case number and jurisdiction Professional Licenses or Disciplinary Actions

Conflicts of Interest: Check if any potential conflicts exist.

If checked, describe the nature of the conflict

PAYMENT TERMS

Total Compensation to Declarant:

Payment Schedule / Milestones

Late Payment Fee: Interest or collection costs shall be charged as described above unless prohibited by law.

TERM AND TERMINATION

Term Commencement Date: Term End Date (if applicable):

Termination Notice Requirement

Either party may terminate for material breach if the breaching party fails to cure within the notice period above. Termination does not relieve a party of obligations accrued prior to termination, including payment and confidentiality obligations that are expressly stated to survive.

CONFIDENTIALITY

The parties acknowledge that in the course of performance Declarant and the Requesting Party may disclose confidential information. Each party shall hold in confidence and shall not disclose Confidential Information except as required by law or with the prior written consent of the disclosing party. Confidential Information does not include information that is or becomes publicly available through no fault of the receiving party or that was already lawfully in the receiving party's possession.

This confidentiality obligation shall survive termination or expiration of this Agreement for a period of three (3) years, or longer where required by applicable regulation or contract.

AUTHORIZATION AND CERTIFICATION

Declarant hereby certifies that the information provided in this Background Information Declaration is true, complete and correct to the best of Declarant's knowledge. Declarant authorizes the Requesting Party and its agents to obtain consumer or investigative background reports and to contact references and prior employers for the purpose of verifying this information and assessing fitness for the engagement.

Declarant understands that any materially false statement, omission, or failure to disclose information required by this Declaration may constitute grounds for termination of the engagement and may subject Declarant to civil or criminal penalties where applicable.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the jurisdiction indicated below, without regard to conflict of laws principles.

Governing Jurisdiction

ENTIRE AGREEMENT

This document, together with any attachments and any written amendments executed by the parties, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals, and understandings, whether written or oral. Any modification or waiver of any provision of this Agreement must be in writing and signed by both parties.

ADDITIONAL REPRESENTATIONS

Employment History Summary Professional References

By executing below, Declarant certifies under penalty of perjury that all statements made in this Background Information Declaration are true and complete.

Declarant (Print Name):

By:

Date:

Requesting Party (Print Name):

By:

Date:

What the Background Information Declaration Is

Background Information Declaration is a standardized document used to summarize an individual's personal, professional, and legal background for review by an organization. It collects biographical data, employment history, education credentials, licensing, criminal history disclosures, and other facts relevant to eligibility, onboarding, background checks, or regulatory compliance. The form serves as a factual declaration signed under penalty of perjury where applicable, establishing a clear record of disclosures and dates. It is suitable for use in hiring, contracting, licensing, and certain government or financial processes that require verified background details.

Why a Clear Declaration Matters

Using a Background Information Declaration creates a concise, auditable record of an individual's disclosures that supports compliance, hiring decisions, and due diligence. It reduces ambiguity, centralizes required facts, and provides a signed statement that can be retained as part of official personnel or vendor files.

Who Typically Completes or Requests This Declaration

Common users include HR professionals, licensing boards, contracting officers, and background-screening vendors who need verified disclosures.

Human resources teams managing new hire onboarding and pre-employment checks.
Professional licensing boards verifying credentials, disciplinary history, and disclosure statements.
Contract managers and procurement teams evaluating vendor integrity and subcontractor histories.

The declaration suits organizations across private and public sectors that require documented background evidence for compliance.

Step-by-Step: Completing the Declaration

Follow these sequential steps to complete the Background Information Declaration accurately and in order to support verification and recordkeeping.

01

Prepare Documents: Gather ID, resumes, licenses, and court records before you begin.
02

Complete Fields: Enter data exactly; use MM/DD/YYYY for dates.
03

Attach Evidence: Upload PDFs of IDs, certificates, and release forms.
04

Review & Sign: Verify accuracy, then sign and date the declaration.

How Digital Submission Works

Digital submission simplifies verification: upload, populate fields, request eSignatures, and store an auditable record compatible with legal standards.

Upload: Import PDF or DOCX of the declaration.
Tag Fields: Place name, date, and signature fields for signers.
Authenticate: Use email, SMS, or stronger ID verification as required.
Complete: Signers receive copies and the platform stores audit trails.

Configuring an Online Workflow

Configure an online workflow to collect Background Information Declarations consistently, reduce errors, and enforce required fields.

Field	Configuration
Authentication	Email or SMS code; optional KBA for high-risk cases
Field Validation	Require MM/DD/YYYY, mandatory name and address fields
Notifications	Auto emails on completion to admin and signer
Storage	Encrypted, retain per retention policy (see retention section)

Delivery Channels and Integration Considerations

Acceptable distribution channels include secure email, signing links, API integration, and in-person kiosk modes depending on workflow needs.

Supported Formats: PDF, Word DOCX, and HTML supported
Integrations: Salesforce, NetSuite, Microsoft 365, Google Workspace
Authentication Options: Email link, SMS code, SSO, KBA

Security and Compliance Essentials

Encryption: TLS 1.2/1.3 in transit; AES-256 at rest

Certifications: SOC 2 Type II, ISO 27001, PCI DSS

HIPAA: BAA available; supports PHI processing

ESIGN/UETA: Compliant with ESIGN and UETA standards

Audit Trail: Timestamped events, IP, signer attribution

Access Controls: SSO, role-based permissions, session timeouts

Timing Considerations and Deadlines

Key timing rules affect when you must collect, file, and retain Background Information Declarations; follow organizational and legal deadlines carefully.

Provide on Request:

Supply declaration when employer or regulator requests

Concurrent with Hire:

Collect before or at start of employment

Renewal Intervals:

Update annually or as contract terms require

Retention Minimums:

Keep for at least three years after termination

Expunged Records:

Follow state rules for sealed or expunged disclosures

Key Processing Milestones

Typical processing milestones track collection, verification, approval, and archival; each stage has distinct responsibilities and expected durations.

01

Collection

Applicant completes form and uploads supporting documents

02

Verification

Background vendor or HR authenticates records and flags discrepancies

03

Decision

Hiring manager or licensing board reviews findings and decides

04

Archival

Signed record is stored with audit trail per retention policy

Common Preparation Errors to Avoid

Omitting middle names or using nicknames often causes identity mismatches that delay verification and can trigger manual review cycles with background vendors.
Entering inconsistent employment dates or employer names can lengthen investigations and require additional documentation such as pay stubs or W-2s to verify history.
Failing to disclose sealed or expunged records when the form explicitly requests past convictions leads to compliance risk and possible disciplinary action.
Uploading low-resolution IDs or incorrect file formats causes rejections; provide clear, legible PDFs to prevent processing delays and repeat requests.

Penalties and Legal Risks of Incorrect or Missing Information

Incorrect Tax Reporting: Penalties under IRC §6721 apply

I-9 Violations: Penalties $281–$2,789 per violation

False Statements: Perjury or civil liability risk

Data Breach Liability: Fines under HIPAA possible

Delayed Processing: Background checks may be rejected

Missing Signatures: Document may be unenforceable

Practical Examples From Real-World Use

Real-world examples show how the Background Information Declaration supports hiring, contractor onboarding, and licensing decisions across sectors.

Optica Ventures

Optica Ventures used a standardized declaration to consolidate candidate disclosures and speed background validations across distributed recruiting teams.

Result: fewer verification cycles and faster hires.
By centralizing disclosures, the company reduced back-and-forth with candidates and created an auditable, signed record used for audits and compliance checks, improving consistency across offices and reducing administrative burden on recruiters.

Martin Properties

Martin Properties transitioned leasing and tenant screening to a digital declaration that tenants can complete remotely before lease execution.

Result: faster lease closings and fewer errors.
Tenant onboarding moved online, signature capture integrated with property management systems, and records were retained securely for audits and future tenant inquiries, reducing in-person appointments and improving document accessibility for managers.

eSignature Pricing and Feature Comparison

Side-by-side vendor pricing and feature indicators to help compare options for electronic handling of Background Information Declarations.

	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 by plan	Varies by plan	Limited trial	Limited trial
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 by plan	Varies by plan	Varies by plan

Frequently Asked Questions

Answers to common questions about completing, signing, and storing Background Information Declarations, including eSignature and notarization concerns.

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