Can the form be signed electronically?

Yes. Electronic signatures are legally valid under the ESIGN Act (15 U.S.C. chapter 96) and UETA where adopted, provided intent, consent, attribution, and record retention are satisfied.

What if a candidate refuses to sign?

If authorization is refused, you cannot obtain a consumer report for employment purposes; document the refusal and proceed under your hiring policy without the report.

How are adverse actions handled?

When relying on a consumer report, provide the candidate a copy and the FCRA summary before final adverse action, then issue a final adverse-action notice with required information.

Do I need notarization or witnesses?

Generally no for background authorizations; notarization is rarely required unless state law or a specific employer policy mandates it.

How long must I keep signed declarations?

Retain signed consents for a minimum of three years; I-9 records follow their separate retention rule (8 CFR §274a.2) and HIPAA-related documents six years where applicable.

What if the report contains errors?

Allow the candidate to dispute inaccuracies with the reporting agency; document the dispute, re-investigate, and correct any incorrect information before adverse action where feasible.

Electronic Signature
Templates
HR
Employment Background Check Declaration

Employment Background Check Declaration

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

EMPLOYMENT BACKGROUND CHECK DECLARATION

Employer Name:

Personal Information

Full Legal Name Other Names or Aliases Used Current Address

Phone

Email

Date of Birth

Social Security Number

Position Information

Position Applied For Department Reporting Manager (name)

Proposed Start Date: Proposed Salary:

Authorization for Background Checks

I, , hereby authorize the Employer, its agents, contractors and representatives to obtain background information about me for purposes of evaluating my application and employment status. This authorization includes, but is not limited to, the following checks as selected below.

I consent to the following types of background checks (select all that apply): Criminal history and public records Consumer credit report (where job-related and permitted by law) Motor vehicle records and driving history Education and credential verification Prior employment verification and reference checks Drug and alcohol testing where required

I understand that information obtained may include, but is not limited to, criminal records, credit history, driving records, education and employment history, professional licenses, and other public records. I further understand that a consumer report and/or investigative consumer report may be obtained and that I have the right to request additional disclosures related to such reports where required by law.

Employment History

Employer 1

Company Name Company Address

Title / Position

Supervisor

Phone

From

To

Primary Duties Reason for Leaving

Employer 2

Company Name Company Address

Title / Position

Supervisor

Phone

From

To

Primary Duties Reason for Leaving

Education

Highest Degree or Certification Institution Graduation Date

Professional References

Reference 1

Name Phone Email Relationship

Reference 2

Name Phone Email Relationship

Reference 3

Name Phone Email Relationship

Legal Notices and Disclosures

At-Will Employment: If hired, my employment with the Employer will be at-will unless a written agreement signed by an authorized representative of the Employer provides otherwise. Either I or the Employer may terminate employment at any time, with or without cause, and with or without notice, to the maximum extent permitted by law.

Equal Opportunity: The Employer provides equal employment opportunities to all applicants and employees without regard to race, color, religion, sex, national origin, age, disability, genetic information or any other protected characteristic under applicable law.

Accuracy and Adverse Action: I certify that the information I have provided is true, correct and complete. I understand that falsification, omission or misrepresentation of information may disqualify me from employment or result in termination. If the Employer takes any adverse action based on information obtained through background checks, I understand I may be entitled to receive a copy of the report and a description of my rights under applicable law where required.

Applicant Certification and Authorization

By signing below, I certify under penalty of perjury that the information I have provided on this form is true and complete. I authorize the Employer and its agents to contact any person or entity listed on this form, to request and receive information concerning my background, and to perform all checks selected above. I release from liability all persons, companies and organizations that provide information in good faith.

Acknowledgment I certify that all information provided is true and complete and I authorize the background checks described above. I understand that information obtained will be used only for employment purposes and handled in accordance with applicable privacy laws.

Name:

Signature:

Date:

What the Employment Background Check Declaration Is

An Employment Background Check Declaration is a signed document in which a job applicant authorizes an employer or its agent to obtain consumer or investigative background information for hiring decisions. The form records the applicant's identity details, explicit consent to the scope of the check, and acknowledgment of required disclosures under federal and state law, including the Fair Credit Reporting Act (FCRA) where applicable. It centralizes authorization, consent language, and signature evidence so employers can document compliance when ordering consumer reports or investigative screenings.

Why a Clear Declaration Matters for Hiring

A precise declaration documents consent, narrows authorized screening types, and creates an audit trail for compliance with FCRA and state privacy laws. Clear wording reduces the risk of procedural errors and supports defensible hiring decisions in the event of adverse-action disputes.

Who Typically Completes This Form

Employers, HR teams, third-party screening vendors, and applicants use the declaration to document consent and scope before a background check is ordered.

Employers and HR teams who need auditable consent for consumer and investigative reports in hiring workflows.
Screening vendors who require a signed authorization to proceed with county, credit, or investigative checks.
Job applicants providing standardized consent and identifying data for verifiable results.

Maintain a signed copy in the hiring file and the candidate record to meet retention and dispute-resolution needs.

Core Elements to Include in the Declaration

A compliant declaration combines identity fields, explicit authorization language, scope limits, disclosures, and signature evidence. Each component supports a defensible, auditable screening process.

Consent and Disclosure

A clear authorization statement that explains the types of reports to be obtained, includes FCRA-mandated language where consumer reports are used, and notifies the applicant of their rights under federal and state law.

Identifying Data

Full legal name, prior names, date of birth, and sufficient address history to allow accurate matching against public records and criminal history databases without producing false positives.

Scope of Screening

Specify the categories authorized (criminal history, driving records, credit report, employment verification, education verification, drug testing) and any temporal limits or geographic scope for the search.

Limitations and Timing

State any timing constraints (conditional offer requirement, date range for convictions) and whether the check will occur only after a conditional offer, per local ban-the-box rules.

Adverse-Action Process

Explain that a copy of the report and a consumer’s summary of rights will be provided before any adverse action and describe the final adverse-action notice process.

Signature and Date

A dated signature block for the applicant and space for the screener to record receipt, ensuring attribution and retention of the consent record.

Step-by-Step: Completing and Using the Declaration

Follow these sequential steps to collect, review, and act on background screening authorizations.

01

Collect Consent: Obtain written or electronic authorization before ordering any report.
02

Verify Identity: Match name, DOB, and address to reduce false positives.
03

Order Report: Send the authorized scope to your screening vendor.
04

Document Action: Record results, provide disclosures, and retain signed consent.

How to Configure an Online Screening Workflow

Map form fields, signer roles, and conditional steps when setting up an electronic declaration workflow.

Field	Configuration
Consent Checkbox	Required; conditional upload enabled
SSN Field	Masked input; secure storage
Adverse Action Step	Trigger pre-adverse notification
Record Retention	Auto-archive signed record

Typical Routing: From Candidate to Screening Report

Understand the common flow so each party knows where responsibility and records reside.

Candidate Signs: Applicant completes and signs declaration.
Employer Orders: HR transmits scoped request to vendor.
Vendor Reports: Screening provider returns findings.
Employer Responds: Adverse-action steps or hiring move forward.

Technical Requirements for Electronic Declarations

Electronic completion requires secure form hosting, reliable signer attribution, and retained audit logs to meet legal tests for e-signatures.

File Formats: PDF or DOCX accepted
Authentication: Email, SMS, or stronger
Audit Trail: IP, timestamp, action log

Choose a platform that supports conditional fields, encrypted storage, and exportable audit evidence for regulatory review.

Security and Compliance Elements to Record

Encryption: TLS 1.2/1.3 in transit

Data at Rest: AES-256 encrypted storage

Regulatory Coverage: ESIGN and UETA compliant

Healthcare: HIPAA (BAA required)

Audit Trail: Tamper-evident logs

Certifications: SOC 2 Type II; ISO 27001

Primary Penalties and Legal Risks

FCRA Violations: Civil damages and statutory fines

I-9 Noncompliance: Potential DHS fines per violation

Discrimination Claims: EEOC litigation risk for misuse

Privacy Breaches: State penalties and notification costs

Defamation Risk: Claims from inaccurate reporting

Contract Exposure: Vendor indemnity disputes

Common Mistakes When Preparing a Declaration

Using vague consent language that fails to specify report types and scope, exposing the employer to FCRA challenges and vendor disputes.
Collecting excessive personal data without a documented business need, increasing privacy risk and state-law exposure regarding data minimization.
Failing to provide the required consumer disclosures and a copy of the rights summary before taking adverse action under FCRA.
Not retaining signed consents or audit logs in a searchable file, which complicates dispute resolution and regulatory inspections.

Timing and Key Compliance Deadlines

Adhere to procedural timing requirements for consent, reporting, and adverse-action notifications to reduce legal risk.

Consent Before Screening:

Obtain written or electronic authorization before ordering any consumer report (FCRA, 15 U.S.C. §1681b).

Pre-Adverse Action:

Provide a copy of the report and a summary of rights before final adverse action when relying on a consumer report.

Final Adverse Notice:

Send a clear adverse-action notice after the hiring decision is made, including notice of the consumer reporting agency used.

I-9 Retention Rule:

Retain I-9s for three years after hire or one year after termination, whichever is later (8 CFR §274a.2).

Record Retention Start:

Retention periods run from creation or from the final hiring decision, depending on the document type and regulation.

How Organizations Use the Declaration in Practice

Real-world examples show how standard declaration forms streamline screening and support compliance across sectors.

Optica Ventures — COO

Optica standardized the declaration to speed candidate intake while ensuring consent was captured uniformly.

The interface was made simple and mobile-friendly to increase completion rates.
"The interface is simple and easy-to-use for our team; more importantly, it is just as easy for our customers."

Fertility Centers — Founder

A healthcare provider adapted the declaration to include HIPAA handling and vendor BAAs.

They required signed electronic consent before any health-related screening.
"The airSlate SignNow team has been exceptional, responsive, the API has been great, and we're extremely happy that we chose airSlate SignNow as a company."

Practical Tips for Accurate and Efficient Declarations

Small procedural steps reduce errors and legal exposure while improving candidate experience.

Standardize Language

Use a consistent authorization template that includes the specific types of reports authorized, FCRA disclosures when applicable, and a clear signature block to minimize rework.

Limit Scope

Request only the checks necessary for the position to reduce privacy risk and avoid unnecessary adverse-action exposure; tailor scope by role.

Use Audit Trails

Keep electronic timestamps, IP addresses, and copies of disclosures to demonstrate consent and attribution if challenged.

Train HR

Ensure HR staff understand pre-adverse and adverse-action steps and local state rules to avoid procedural violations.

Comparing eSignature Options for Declarations

Basic pricing and feature distinctions across common eSignature vendors help choose a platform that supports secure, auditable declaration 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 by offer	Varies by offer	Varies by offer	Varies by offer
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

Frequently Asked Questions About the Declaration

Answers to common legal, procedural, and technical questions encountered when using background check authorizations.

Need help? Contact support

Can the form be signed electronically?
Yes. Electronic signatures are legally valid under the ESIGN Act (15 U.S.C. chapter 96) and UETA where adopted, provided intent, consent, attribution, and record retention are satisfied.
What if a candidate refuses to sign?
If authorization is refused, you cannot obtain a consumer report for employment purposes; document the refusal and proceed under your hiring policy without the report.
How are adverse actions handled?
When relying on a consumer report, provide the candidate a copy and the FCRA summary before final adverse action, then issue a final adverse-action notice with required information.
Do I need notarization or witnesses?
Generally no for background authorizations; notarization is rarely required unless state law or a specific employer policy mandates it.
How long must I keep signed declarations?
Retain signed consents for a minimum of three years; I-9 records follow their separate retention rule (8 CFR §274a.2) and HIPAA-related documents six years where applicable.
What if the report contains errors?
Allow the candidate to dispute inaccuracies with the reporting agency; document the dispute, re-investigate, and correct any incorrect information before adverse action where feasible.

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