Can I ask about arrests as well as convictions?

Many jurisdictions restrict asking about arrests that did not lead to conviction. Ask only what is lawful in the applicant’s jurisdiction and limit requests to convictions when required by local fair-chance rules to avoid discrimination risk.

When must I delay inquiries under fair-chance laws?

Several states and localities require delaying criminal-history questions until after a conditional offer; check the specific jurisdictional rule before collecting details to ensure compliance with local statutes and ordinances.

How should sealed or expunged records be handled?

If a conviction is sealed or expunged, many jurisdictions prohibit asking about it or using it in hiring decisions; obtain legal guidance and note in policy how sealed records are treated to avoid unlawful discrimination.

Is an electronic signature legally valid for this form?

Yes. Electronic signatures meet the ESIGN Act (15 U.S.C. ch. 96, 2000) and UETA requirements where adopted, provided intent, consent, attribution, and record retention are satisfied.

Do I need separate consent for a background check?

Yes. Obtain clear, written authorization prior to conducting background checks; consumer-facing financial or healthcare-related forms may require an ESIGN consumer disclosure per federal law.

How long must I retain completed questionnaires?

Retention depends on the record type and applicable law: I-9 rules apply (8 CFR §274a.2), IRS and employment records typically three years, and HIPAA-related items six years; follow the longest applicable retention period.

Electronic Signature
Templates
HR
Employment Criminal History Questions

Employment Criminal History Questions

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

EMPLOYMENT CRIMINAL HISTORY QUESTIONS

Personal Information

Full Name Current Address Primary Phone Email Address Date of Birth

Position Information

Position Applied For Department Hiring Manager Anticipated Start Date Proposed Salary or Pay Rate

Criminal History Questions — Applicant Response Required

Notice: The information requested below will be used to assess criminal history only to the extent it is job-related and consistent with business necessity. A conviction will not necessarily disqualify an applicant. Except where prohibited by law, you must fully disclose convictions, deferred adjudications, pleas, or guilty findings as described below. Failure to disclose required information may result in denial of employment or termination.

1. Have you ever been convicted of, pleaded guilty to, or entered a plea of nolo contendere to any felony? Yes No

2. Have you ever been convicted of, pleaded guilty to, or entered a plea of nolo contendere to any misdemeanor? Yes No

3. Are any criminal charges pending against you at this time? Yes No

4. Have you ever been incarcerated or served a sentence (including probation or parole) within the past seven (7) years? Yes No

5. Have you ever had a criminal record sealed, expunged, vacated, or otherwise set aside? (Answering Yes does not necessarily require disclosure where prohibited by law; if unsure, consult the certification below and disclose to the extent required.) Yes No

If you answered "Yes" to any of the above questions, provide complete details for each matter. Include offense, jurisdiction, date, charge, disposition, and sentence. Attach additional pages if necessary.

Offense 1 — Description and Details Offense 1 — Date of Conviction/Disposition Offense 1 — Jurisdiction Offense 1 — Disposition / Sentence Offense 2 — Description and Details Offense 2 — Date of Conviction/Disposition Offense 2 — Jurisdiction Offense 2 — Disposition / Sentence

Employment History (Most Recent First)

Employer 1 — Company Name Employer 1 — Job Title

Start Date

End Date

Employer 1 — Primary Duties / Responsibilities Employer 1 — Reason for Leaving Employer 2 — Company Name Employer 2 — Job Title

Start Date

End Date

Employer 2 — Primary Duties / Responsibilities Employer 2 — Reason for Leaving

Education

Highest Degree or Diploma Institution Graduation Date

References (Professional)

Reference 1 — Name Reference 1 — Phone Reference 1 — Email Reference 1 — Relationship Reference 2 — Name Reference 2 — Phone Reference 2 — Email Reference 2 — Relationship Reference 3 — Name Reference 3 — Phone Reference 3 — Email Reference 3 — Relationship

Legal Disclosures and Applicant Certification

At-Will Employment: If hired, your employment will be at-will unless a separate written agreement signed by an authorized company representative states otherwise. Either you or the employer may terminate employment at any time, with or without cause or advance notice.

Equal Opportunity: The employer is an equal opportunity employer and does not discriminate unlawfully. Criminal history information will be considered only where job-related and consistent with business necessity and applicable law.

Authorization and Release: I certify that all information provided on this form is true and complete to the best of my knowledge. I authorize the company and its agents to investigate and verify any information provided, including obtaining criminal history records and contacting former employers and references. I release from liability any person or entity providing information in good faith. I understand that falsification, omission or misstatement of material facts may result in denial of employment or immediate termination if hired.

Consent to Background Check

I consent to a criminal background check and verification of the information provided above.

Authorization to Contact Past Employers

I authorize the company to contact my previous employers and listed references regarding my employment record and suitability for employment.

Applicant Certification — Statement of Truth

By signing below, I certify under penalty of perjury that the foregoing information is true and complete. I understand that this form will be relied upon as part of my application for employment and that the employer may retain this form whether or not I am employed.

Applicant Name:

Signature:

Date:

What the Employment Criminal History Questions are and why they exist

The Employment Criminal History Questions are a standardized applicant questionnaire used by employers to collect disclosure of prior criminal convictions, adjudications, or pending matters that may be relevant to hiring. These questions typically accompany an application or background-check consent form and are designed to document applicant-provided information consistently while enabling compliance checks with federal, state, and local fair-chance laws and privacy rules. Employers use the collected answers to evaluate job-related risk, verify identity for background checks, and maintain a defensible record of screening decisions.

Why a clear criminal-history questionnaire matters

A well-crafted Employment Criminal History Questions form reduces legal risk, ensures consistent hiring decisions, and documents applicant disclosures for audit and compliance purposes. It helps employers meet obligations under EEOC guidance, state fair-chance laws, and record retention rules while supporting defensible, job-related screening practices.

Which organizations and roles typically use these questions

Public-sector employers, healthcare providers, financial institutions, and companies in regulated industries often apply stricter procedures; local laws may further shape timing and allowable questions.

Human resources teams and recruiters who collect applicant data and coordinate background checks.
Hiring managers for roles with safety, financial, or regulatory responsibilities requiring screening.
Third-party background-screening vendors who need applicant-provided details to run searches.

Core components of a professional criminal-history questionnaire

A compliant form balances concise data collection with legally required disclosures and consent. Key components make the form usable, defensible, and compatible with digital workflows.

Identity fields

Full legal name, date of birth, and other identifiers to match background checks and reduce mismatches.

Conviction disclosure

Clear fields for convictions, dates, jurisdictions, and case numbers with space for contextual explanation.

Arrest vs conviction

Separate prompts for arrests not resulting in conviction if state/local rules permit asking.

Consent and authorization

Explicit consent to run background checks and a signature block for applicant authorization.

Conditional-offer sequencing

Language and timing fields to delay inquiries until after conditional offer when required by law.

Recordkeeping note

Retention statement describing how long responses are kept and who has access.

Required fields commonly included in the questionnaire

Full legal name: First, middle, last

Date of birth: MM/DD/YYYY format

Conviction details: Date, offense, jurisdiction

Case or docket number: If available

Consent checkbox: Background check authorization

Signature and date: Typed or signed electronic signature

Step-by-step: collecting criminal-history disclosures

Follow a consistent sequence to ensure legal compliance and reduce data errors when gathering criminal-history information from candidates.

01

Prepare form: Include consent, clear questions, and retention notice.
02

Timing check: Verify state/local fair-chance rules before asking.
03

Collect data: Have applicant complete required fields and sign.
04

Run screening: Authorize background check and reconcile results.

Configuring the online workflow for digital completion

Set up an electronic form and routing that enforces timing rules, captures consent, and logs audit data for each submission.

Form hosting	Secure PDF or web form with field validation
Conditional fields	Show conviction fields only after consent and eligibility checks
Signer authentication	Email plus optional SMS or ID verification
Audit trail	Record IP, timestamp, and actions
Retention policy	Automatic archival per retention rules

Technical and security requirements for e-submission

Ensure the vendor can supply a Business Associate Agreement for HIPAA-covered contexts and supports ESIGN/UETA compliance, secure storage, and role-based access controls.

Encryption: TLS 1.2/1.3 in transit
Data at rest: AES-256 encryption
Audit capabilities: IP, timestamp, activity log

Where completed questionnaires go and who receives them

Define a clear routing path so completed questionnaires are securely delivered to the right parties for review and background checks.

Applicant submission: Candidate fills and signs the form online
HR intake: Form routes to HR intake queue
Background vendor: Vendor receives authorization and runs checks
Decision logging: HR records result and compliance notes

Timing considerations and statutory deadlines to watch

Observe federal and local timing rules: background checks, I-9 completion, and tax or payroll reporting have different deadlines and retention triggers.

I-9 retention:

Complete Form I-9 per hire; retain 3 years after hire or 1 year after termination (8 CFR §274a.2)

Conditional-offer timing:

Delay conviction-history questions until after conditional offer when required by state/local laws

Background-search turnaround:

Allow vendor 3–10 business days depending on jurisdictions searched

EEOC adverse-action timing:

Provide pre-adverse notice and final adverse notice per company policy and EEOC guidance

Retention trigger:

Retention periods start from hire, termination, or last action depending on statute

Key milestones in the screening and hiring timeline

Map the main milestones so hiring teams and candidates understand when disclosures, checks, and decisions occur.

01

Application submitted

Candidate completes questionnaire and signs

02

Conditional offer

Employer issues conditional offer when required

03

Background check

Vendor completes checks and returns results

04

Adverse-action step

Pre-adverse notice, opportunity to respond, final notice

Common mistakes to avoid when preparing the questionnaire

Asking about arrests or non-convictions where local law forbids it, which creates legal exposure and potential discrimination claims.
Failing to delay criminal-history questions until after a conditional offer when required by state or local fair-chance laws.
Keeping responses without a clear retention policy or access controls, risking privacy violations or inadvertent disclosure.
Using inconsistent question wording across roles or locations, which undermines defensibility and equal-treatment documentation.

Penalties and legal risks from incorrect or improper use

Disparate-impact claims: EEOC enforcement risk

State fines: Penalties under local fair-chance laws

I-9 violations: Civil fines (8 CFR §274a.2)

Privacy breaches: Damages and regulatory action

Adverse-action errors: Failure to provide notices

Recordkeeping lapses: Inability to defend hiring decisions

Example ways employers use the questionnaire in practice

Two concise real-world examples show how the form supports compliant hiring and background screening.

Healthcare hiring

A hospital collects disclosures during conditional offer stage

Background vendor confirms convictions
The hospital documents job-related risk and retains evidence for 6 years to meet HIPAA and audit needs.

Property management

A leasing company asks after conditional offer

Screening returns a relevant conviction
Manager documents individualized assessment and job-related reasoning to limit disparate-impact claims.

Practical tips for accurate and efficient completion

Adopt processes that reduce errors, protect privacy, and make decisions defensible.

Limit questions by role

Ask only job-related criminal-history questions and document the legitimate business reason for each role to avoid disparate-impact claims.

Delay when required

Comply with fair-chance timing — collect detailed criminal-history only after a conditional offer when the law requires.

Capture consent clearly

Use explicit, dated authorization language for background checks and store a signed copy with the applicant record.

Log individualized assessments

When adverse action is contemplated, document the analysis tying convictions to job duties and cite rehabilitation or mitigating factors considered.

Comparing eSignature vendor starting prices and core features

Basic pricing and a few key capabilities to consider when choosing an eSignature provider for Employment Criminal History Questions and related HR forms.

	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	Free trial available	Free trial available	Free trial available	Free trial available
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 about Employment Criminal History Questions

Answers to common legal and practical questions when using criminal-history questionnaires in hiring and background-check workflows.

Need help? Contact support

Can I ask about arrests as well as convictions?
Many jurisdictions restrict asking about arrests that did not lead to conviction. Ask only what is lawful in the applicant’s jurisdiction and limit requests to convictions when required by local fair-chance rules to avoid discrimination risk.
When must I delay inquiries under fair-chance laws?
Several states and localities require delaying criminal-history questions until after a conditional offer; check the specific jurisdictional rule before collecting details to ensure compliance with local statutes and ordinances.
How should sealed or expunged records be handled?
If a conviction is sealed or expunged, many jurisdictions prohibit asking about it or using it in hiring decisions; obtain legal guidance and note in policy how sealed records are treated to avoid unlawful discrimination.
Is an electronic signature legally valid for this form?
Yes. Electronic signatures meet the ESIGN Act (15 U.S.C. ch. 96, 2000) and UETA requirements where adopted, provided intent, consent, attribution, and record retention are satisfied.
Do I need separate consent for a background check?
Yes. Obtain clear, written authorization prior to conducting background checks; consumer-facing financial or healthcare-related forms may require an ESIGN consumer disclosure per federal law.
How long must I retain completed questionnaires?
Retention depends on the record type and applicable law: I-9 rules apply (8 CFR §274a.2), IRS and employment records typically three years, and HIPAA-related items six years; follow the longest applicable retention period.

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