Is an electronic signature legally valid?

Yes. Electronic signatures are legally enforceable under the federal ESIGN Act (15 U.S.C. §7001) and by UETA in most states when intent, consent, attribution, and record retention are satisfied.

Can applicants be asked about expunged records?

State law governs. Many states prohibit asking about sealed or expunged convictions; verify with state statutes before including such questions.

Do employers need to notarize the statement?

Not typically. Notarization is rarely required for employment disclosures, but some roles or state rules may request notarized attestations; consult applicable law.

What if a candidate refuses to consent?

If consent is necessary for a position, refusal may preclude background checks and could impact hiring, but employers must apply policies consistently to avoid disparate treatment.

How long must signed statements be kept?

Retention varies: keep for at least the active term plus relevant federal minimums (e.g., 3 years for many records) and industry mandates such as HIPAA (6 years).

Can I use signNow to collect signatures?

signNow supports legally binding eSignatures, audit trails, and compliance standards including ESIGN, UETA, SOC 2, ISO 27001, and HIPAA (BAA available), making it suitable for secure electronic collection where permitted.

Electronic Signature
Templates
HR
Employment Criminal Record Statement

Employment Criminal Record Statement

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

Employment Criminal Record Statement

Personal Information

Full Legal Name Current Address

Phone Number

Email Address

Position Information

Position Applied For Department / Hiring Manager

Proposed Start Date:

Offered Salary / Rate:

Employment History

Employer 1

Company Name Job Title

From:

To:

Primary Responsibilities Reason for Leaving

Employer 2

Company Name Job Title

From:

To:

Primary Responsibilities Reason for Leaving

Education

Highest Degree or Certification Institution Graduation Date

References

Reference 1

Reference 2

Reference 3

Legal Disclosures

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

Equal Opportunity: The employer provides equal employment opportunity without regard to race, color, religion, sex, national origin, age, disability, genetic information, or any other characteristic protected by applicable law. Selections are based on qualifications, merit and business need.

Criminal Record Disclosure

Applicants must disclose any criminal convictions. Conviction means a plea or verdict of guilty, or a conviction following a plea of nolo contendere. A conviction will not automatically disqualify you from employment; all circumstances will be considered. Failure to disclose a conviction may result in withdrawal of the job offer or termination if employed.

Have you ever been convicted of a misdemeanor or felony?

Yes No

If yes, provide details for each conviction. If more space is needed, attach a separate sheet and initial it.

Conviction 1

Offense

Date:

Jurisdiction:

Disposition:

Sentence / Penalty Sealed or Expunged

Conviction 2

Offense

Date:

Jurisdiction:

Disposition:

Sentence / Penalty Sealed or Expunged

Have you ever been arrested for a criminal offense that did not result in a conviction?

Yes No Additional Explanation (if applicable)

Authorization and Release

I authorize the employer and its agents to obtain consumer reports, criminal background checks, and other investigative reports for employment purposes. I authorize any person, school, current or former employer, law enforcement agency, court, or other entity to release records or information they may have regarding me to the employer or its agents. I release all such parties from any liability for providing this information.

I understand that information obtained from these sources may be used to evaluate my suitability for the position applied for. I further understand that I may be required to provide fingerprinting or other information as part of the background investigation if requested.

I consent to the background checks and releases described above.

Applicant Certification

I certify that all information provided on this form and any attachments is true, complete, and correct to the best of my knowledge. I understand that any false, misleading, or omitted information may result in withdrawal of any offer of employment or termination of employment if discovered after hire.

I certify the above statement.

Applicant Name:

Signature:

Date:

What the Employment Criminal Record Statement Is and When it’s Used

An Employment Criminal Record Statement is a standardized document used by employers to obtain a prospective or current employee’s disclosure about criminal history for hiring, placement, or continued employment decisions. It typically asks about convictions, pending charges, and adjudications, and it may request consent for a background check. Employers use the statement to document applicant responses, meet screening policies, and demonstrate consistent treatment of candidates while remaining aware of legal limits such as ban-the-box rules and fair-chance hiring obligations.

Why a Clear Statement Matters for Hiring and Compliance

A well‑crafted Employment Criminal Record Statement helps employers collect consistent disclosures, reduce legal risk, and document consent for background checks. It supports fair hiring practices and creates a clear paper trail for employment decisions.

Who Prepares and Who Completes the Statement

Employers, HR teams, and background check vendors commonly prepare or distribute this statement to applicants as part of hiring workflows.

Hiring managers and HR teams use the form to ensure consistent screening and to document candidate disclosures across openings.
Background check providers receive signed consent statements to comply with FCRA and to proceed with criminal records searches.
Applicants complete the statement to disclose convictions, provide identifying information, and to authorize background checks where required.

Accurate completion by applicants and consistent handling by employers reduce risk and support compliance with federal and state screening rules.

Step-by-step: completing and returning this statement

Follow these steps to complete the Employment Criminal Record Statement accurately and securely.

01

Receive the form: Open the document and review instructions before entering data.
02

Complete fields: Enter personal details, disclose convictions as requested, and double-check dates.
03

Sign and date: Sign electronically or by hand per the employer’s accepted method.
04

Submit securely: Return via the employer’s secure channel or verified eSignature workflow.

Information security and minimal data to collect

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

PHI Handling: HIPAA requires BAA when health data is present

SSN Minimization: Collect only last four digits when feasible

Access Controls: Role-based access and logging

Audit Trail: Timestamps, IP, and action history

Retention Policy: Store only as long as legally required

Typical routing for the completed statement

This outlines how completed statements typically move through an employer’s screening process.

Submission: Applicant returns the signed statement to HR or the hiring portal.
Verification: HR verifies identity and forwards consent to the background vendor.
Background Check: Vendor conducts criminal record search and reports results back to HR.
Decision: Employer documents adverse action steps if any decision is based on the report.

Settings to configure for an electronic statement workflow

Configure these settings to preserve chain of custody and meet legal requirements for electronic consent.

Field	Configuration
Consent Disclosure	Present mandatory consumer disclosure per ESIGN when consumer-facing
Authentication	Use email plus optional SMS code or stronger auth for sensitive hires
Audit Trail	Enable full action logs with timestamps and IP addresses
Retention	Set archival rules consistent with legal retention timelines

Technical considerations for eSubmission and eSignature

Choose a platform that supports secure storage, audit trails, and the authentication level required for your role.

File Formats: PDF, DOCX supported
Integrations: Works with Salesforce and HR systems
Authentication: Email, SMS, or advanced options

Ensure the platform can export a tamper-evident file and a signed audit certificate to retain evidence of consent and signature attribution.

Timing and deadlines to keep in mind

Use these timelines to manage requests, background checks, and record retention deadlines.

Provide Upon Request:

W-9 style documents are provided upon payer request; no fixed filing deadline.

Background Check Turnaround:

Typical criminal checks return in 1–5 business days depending on jurisdictions searched.

Adverse Action Timing:

Provide pre-adverse and final adverse action notices per FCRA timelines.

I-9 Related:

Keep I-9 supporting records as required: 3 years after hire or 1 year after termination.

Record Retention:

Follow applicable federal and state retention rules documented elsewhere on this page.

Key milestones in the screening and decision process

A sequential view of stages from disclosure to final employment decision helps track compliance steps.

01

Disclosure Received

Applicant returns the completed statement to HR for initial review.

02

Consent Verified

Confirm that the applicant gave informed consent for background checks before ordering.

03

Report Reviewed

Hiring team assesses the background report and documents any relevance to job duties.

04

Adverse Action

If basing decisions on the report, follow FCRA pre‑adverse and adverse action procedures.

Common mistakes to avoid when preparing the statement

Asking for sealed or expunged records when state law prohibits it, which can lead to legal exposure.
Using inconsistent disclosure questions across roles, creating disparate treatment and discrimination risk.
Failing to obtain clear consent before running a background check, violating FCRA consent requirements.
Not documenting the signature method and audit trail for electronic submissions, weakening evidentiary value.

Potential penalties and legal risks from errors

FCRA Violations: Civil liability and statutory damages

I-9 Penalties: Fines ranging by violation severity

Discrimination Claims: Risk of EEOC enforcement actions

State Penalties: Fines or injunctions under state law

Data Breach Costs: Notification and remediation expenses

Invalid Consent: Background results unusable if consent defective

Essential parts of a professional Employment Criminal Record Statement

Ensure the statement includes clear sections for identity, disclosures, consent, and signature to maximize legal clarity and operational usefulness.

Identity Block

Collect full legal name, DOB, and contact details. Accurate identifiers reduce false-positive matches during background screening.

Disclosure Questions

Use precise questions about convictions, pendency, and disposition; avoid overly broad or state-prohibited inquiries.

Consent Language

Include explicit consent for background checks and a plain-language notice if consumer-facing records are used (ESIGN consumer disclosure where required).

Signature Area

Provide space for signature, printed name, and date; specify accepted signature methods (electronic or wet signature).

Certification Clause

A short attestation that the information is true under penalty of law and acknowledges consequences for false statements.

Vendor Authorization

If applicable, name the background-check vendor and scope of searches to show informed consent and limited scope.

Representative scenarios showing how organizations use the statement

Two anonymized examples illustrate typical employer workflows and legal considerations when using the statement.

Public-Sector Hiring

A municipal employer requires a statement for all final hires to document convictions relevant to public trust

The screening uses fingerprint checks where statute requires
The city retains the signed record for seven years and follows specific notice and appeal procedures when adverse action is contemplated.

Healthcare Recruit

A hospital requests the statement plus a HIPAA BAA before onboarding clinical staff

Background checks include state licensing board checks and national criminal searches
The facility keeps records six years under HIPAA and documents any accommodations or regulatory reporting.

eSignature provider pricing and capability snapshot for this workflow

Vendor pricing and key capabilities influence selection for secure, compliant collection of employment screening disclosures; signNow is listed first for parity.

	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	Varies by plan	Varies by plan
Bulk Send	Yes (premium)	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes (BAA available)	Yes	Yes	No	No

Frequently asked questions about using the Employment Criminal Record Statement

Answers to common legal and practical questions about disclosure, eSignature, and recordkeeping for employment criminal history.

Need help? Contact support

Is an electronic signature legally valid?
Yes. Electronic signatures are legally enforceable under the federal ESIGN Act (15 U.S.C. §7001) and by UETA in most states when intent, consent, attribution, and record retention are satisfied.
Can applicants be asked about expunged records?
State law governs. Many states prohibit asking about sealed or expunged convictions; verify with state statutes before including such questions.
Do employers need to notarize the statement?
Not typically. Notarization is rarely required for employment disclosures, but some roles or state rules may request notarized attestations; consult applicable law.
What if a candidate refuses to consent?
If consent is necessary for a position, refusal may preclude background checks and could impact hiring, but employers must apply policies consistently to avoid disparate treatment.
How long must signed statements be kept?
Retention varies: keep for at least the active term plus relevant federal minimums (e.g., 3 years for many records) and industry mandates such as HIPAA (6 years).
Can I use signNow to collect signatures?
signNow supports legally binding eSignatures, audit trails, and compliance standards including ESIGN, UETA, SOC 2, ISO 27001, and HIPAA (BAA available), making it suitable for secure electronic collection where permitted.

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