Employee Background Check Instructions

EMPLOYEE BACKGROUND CHECK INSTRUCTIONS

These instructions describe the scope of the background check process, the documents you must provide, and the authorizations required. Complete all fields accurately. Background checks are a condition of employment or continued employment when authorized by the employer. The employer will rely on the information provided to verify identity, employment eligibility, work history, education, professional credentials, and other relevant records.

Personal Information

Date of Birth:    Social Security Number (last 4):

Position Information

Proposed Start Date:    Salary / Wage:

Employment Type: Full-time Part-time Contractor

Required Documents to Submit

Provide clear copies of the following documents. Originals may be required for in-person verification.

Government-issued photo ID (driver's license or passport)

Proof of current address (utility bill, lease, or similar)

Employment authorization/eligibility documentation

Education diplomas or transcripts (if required)

Professional license or certification (if applicable)

Employment History (Provide at least two entries)

Education

References (Professional) — Provide three

Scope of Background Check

The background check may include verification of identity; prior employment history; education and professional credentials; criminal conviction records; motor vehicle records; drug and alcohol screening; credit history where job related; and reference checks. The employer may obtain consumer reports, investigative consumer reports, and specialty reports from third-party screening providers for the purposes of evaluating eligibility for employment, promotion, or continued employment.

Types of checks requested (select all that apply):

Criminal history / conviction records

Prior employment verification

Education and credential verification

Drug and substance screening

Motor vehicle record / driving history

Credit report (if job related and permissible)

Disclosure, Authorization, and Release

Disclosure: I acknowledge that the employer may obtain consumer reports or investigative consumer reports about me for employment purposes. I understand that such reports may contain information about my character, general reputation, personal characteristics, and mode of living.

Authorization: By signing below, I authorize the employer and its representatives, agents, and screening providers to obtain consumer reports and investigative consumer reports about me and to verify any information provided on my application or in my personnel file. I authorize any person, educational institution, current or former employer, reference, government agency, law enforcement agency, licensing authority, or any other organization to disclose to the employer and its agents all information that may be requested in connection with such background checks.

Release: I release and hold harmless the employer, its agents, and any person or entity providing information in connection with the background check from any liability arising from the employer's use of such information and from the disclosure of such information to the employer. I further release any consumer reporting agency from liability for furnishing any consumer report or information.

Conditional Employment: I understand that employment, promotion, or continued employment may be conditioned on satisfactory completion of required background checks. The employer will provide notice and an opportunity to respond prior to any adverse action based in whole or in part on information obtained through a background check, where required by law.

Applicant Certifications and Authorizations

I certify that all information provided in this form is true, complete, and correct to the best of my knowledge. I understand that omission or misrepresentation of facts may be grounds for denial of employment or immediate termination if discovered after hire.

I authorize the employer to contact the references, employers, schools, and other persons or entities listed in this form and to conduct the background checks described above. I understand that I may be required to provide original documents for verification purposes.

Applicant acknowledgement: I consent to the background checks and releases described above.

Equal Opportunity and At-Will Statement

Equal Opportunity: The employer is an equal opportunity employer. Decisions regarding hiring are made without regard to race, color, religion, sex, national origin, age, disability, genetic information, or any other protected characteristic under applicable law.

At-Will Employment: Unless otherwise provided in a written agreement signed by an authorized representative of the employer, I understand that employment with the employer is at-will. Either the employer or I may terminate the employment relationship at any time, with or without cause or notice.

Additional Applicant Notes

If any part of my name, date of birth, or other identifiers has changed, please list previous names or aliases below to assist with records searches.

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