Employment Background Check Template

EMPLOYMENT BACKGROUND CHECK AUTHORIZATION

Personal Information

Position Information

Full-time Part-time Temporary Contractor

Background Checks to Be Conducted

By signing this Authorization, I understand and expressly authorize the prospective employer, its agents, and any third-party consumer reporting agency retained by the employer to obtain and evaluate consumer reports, investigative consumer reports, and other background information about me for employment purposes. I authorize the following types of inquiries, as applicable:

Employment verification
Education verification
Criminal history and public records search
Motor vehicle records / driving history
Credit report (only where job-related and permitted by law)
Drug/alcohol testing where applicable
Professional and personal reference checks
Professional license and certification verification
International background checks where applicable

Previous Addresses (Last 7 Years)

Employment History

Provide complete and accurate employment history for the last 10 years. Employer 1:

Employer 2:

Education

Professional References

Reference 1

Reference 2

Reference 3

Legal Disclosures and Acknowledgments

I acknowledge that this authorization is voluntary and that information obtained from consumer reporting agencies and other sources may be used in whole or in part as a basis for employment decisions. I understand that where required by law, prior to taking an adverse action based in whole or in part on a consumer report, I will be provided a copy of the report and a written description of my rights 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 and may be terminated by either party at any time, with or without cause or notice.

Equal Employment Opportunity: The employer is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, or other protected characteristic as defined by applicable law.

Authorization and Release

I hereby authorize all persons, institutions, schools, employers, law enforcement agencies, and government agencies to release to the employer, its agents, and consumer reporting agencies any information concerning my background and qualifications. I specifically release such persons and entities from any and all liability and responsibility arising from the release of such information. This authorization shall be valid for the duration of my employment application and, if hired, throughout my employment where permitted by law.

I understand that a copy or electronic reproduction of this Authorization shall be as valid as the original. I further understand that I may withdraw this authorization at any time by providing written notice to the employer, except to the extent that action has already been taken in reliance on this authorization.

Consent to Obtain Consumer Reports and Investigative Reports: I consent to the employer obtaining consumer reports and investigative consumer reports about me for employment purposes, including verification of information provided by me and investigation of my background and references.

By checking this box and signing below, I certify that I have read, understand and agree to the foregoing Authorization and Release.

Applicant Certification

I certify that all information provided on this form and any attachments is true, accurate and complete to the best of my knowledge. I understand that any false statement, omission or misrepresentation may result in denial of employment or, if employed, disciplinary action up to and including termination.

I authorize the employer and its representatives to contact all references, previous employers, educational institutions, licensing entities, and other individuals and entities to obtain information regarding my qualifications, character, and fitness for employment.

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