Can the form be signed electronically?

Yes. Under the ESIGN Act and UETA in most states, electronic signatures are valid for consent and release when intent and consent are documented and the record is retained.

What if names on ID and form differ?

Provide documenting paperwork such as a marriage certificate or court order for name change and include aliases on the form to ensure accurate record matching.

Is notarization always required?

Not universally. Notarization or witnesses are required in some states or for certain official clearances; check state rules or the requesting authority before notarizing.

How long do vendors keep screening records?

Retention varies by vendor and regulation; employers should require vendors to retain records for the employer's required retention period and provide audit access.

What happens if adverse information appears?

Follow pre-adverse and adverse action procedures, provide required notice to the applicant, and document the employer's decision process to reduce legal exposure.

Can a candidate withdraw consent after signing?

Candidates may withdraw consent, but employers should document withdrawal and understand it may prevent completion of screening required for hiring eligibility.

Electronic Signature
Templates
HR
Employment Police Clearance Form

Employment Police Clearance Form

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

EMPLOYMENT POLICE CLEARANCE FORM

Purpose: This form authorizes the employer and its designated agents to request and obtain criminal history, police clearance, fingerprint, and related investigatory records for employment suitability purposes. Completion of this form is mandatory for processing police clearance and background checks required for employment.

Personal Information

Full Legal Name Former / Maiden Names (if any) Date of Birth Place of Birth Current Address Primary Phone Email Address

Identification

Driver's License / Government ID Passport Number (if available)

Address History (Last 5 Years)

Previous Address 1 Previous Address 2 Previous Address 3 (if applicable)

Position Information

Position Applied / Held Department / Unit Reporting Manager Proposed Start Date

Employment History (Most Recent 1)

Employer Name Job Title Dates Employed (From / To) Primary Responsibilities Reason for Leaving

Employment History (Previous 2)

Employer Name Job Title Dates Employed (From / To) Primary Responsibilities Reason for Leaving

Education

Highest Degree or Certification 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

Criminal History Disclosure

Have you ever been convicted of a criminal offense, pled guilty or nolo contendere, or entered a deferred adjudication relating to a criminal matter?

Yes No If Yes, provide full details including dates, jurisdiction, and disposition

Consent, Release and Authorization

By signing this form I authorize the employer, its affiliates, and designated background screening providers to obtain police reports, criminal records, fingerprint checks, and other investigatory reports maintained by law enforcement agencies, courts, and other entities for the purposes of evaluating my fitness for employment. I authorize the release of such records to the employer and acknowledge that such records may be used in whole or in part to make employment decisions.

I consent to the collection and use of criminal history and police clearance information as described above. I consent to fingerprinting for the purpose of obtaining national and/or state criminal records.

I release and hold harmless the employer, its officers, employees, and agents from liability for seeking, obtaining, and using such information, and from any claims that may arise from the release of records by law enforcement agencies and other providers. I understand that a conviction will not necessarily disqualify me from employment; all circumstances will be considered.

I acknowledge and accept the release and hold harmless clause above.

Data Handling and Confidentiality

Records obtained pursuant to this authorization will be maintained confidentially and will be used only for lawful employment-related purposes. The employer will retain results in accordance with applicable record retention policies and legal requirements. Information will be disclosed only to persons who have a legitimate need to know for employment determinations.

Employment Policies Acknowledgment

At-Will Employment: I understand that if offered employment, my employment may be at-will, which means that either I or the employer may terminate the employment relationship at any time, with or without cause or notice, unless a written agreement provides otherwise and is signed by an authorized representative of the employer.

Equal Opportunity: The employer is an equal opportunity employer. Employment decisions are made on the basis of qualifications, merit, and business needs without regard to protected characteristics under applicable law.

Applicant Certification and Acknowledgment

I certify that the information provided on this form is complete, true, and correct to the best of my knowledge. I understand that omission of material facts, falsification, or misrepresentation may result in refusal to hire or immediate dismissal if discovered after hire. I authorize the employer to verify any information provided and to obtain police clearance, criminal history, and related records for employment purposes.

Additional Comments or Explanations

By signing below I certify that I have read, understand, and agree to the terms and authorizations contained in this Employment Police Clearance Form.

Print Name:

Signature:

Date:

What the Employment Police Clearance Form Is

The Employment Police Clearance Form is a standardized document employers or recruiters use to request a background check clearance from a law enforcement agency or authorized vendor. It typically authorizes release of criminal history records, identifies the subject, and records consent for the check. The form helps employers meet pre-employment screening needs, comply with industry-specific suitability rules, and document lawful consent for background checks under federal and state privacy laws.

Why this Form Matters for Hiring and Compliance

The form documents a candidate’s consent, captures identifying details needed to match records, and creates an audit trail for screening decisions. Proper use reduces legal risk, supports consistent hiring practices, and helps employers meet regulatory requirements for safety-sensitive roles.

Who Typically Completes or Receives This Form

Employers, HR teams, background screening vendors, and certain licensing authorities commonly handle the Employment Police Clearance Form.

Hiring managers and HR professionals use the form to obtain criminal history information for employment decisions.
Background screening companies receive the form and candidate consent to run checks with law enforcement or national databases.
Regulatory agencies or licensing boards may require a cleared form for positions in healthcare, education, or government.

Keep copies of completed forms with personnel records and follow applicable retention rules for investigative or employment documentation.

Core Sections Found on a Professional Police Clearance Form

A complete form groups identity details, consent language, search parameters, disclosure statements, requester details, and signature blocks for clarity and legal validity.

Identity

Full legal name, aliases, date of birth, place of birth, and government ID number to ensure accurate record matching and avoid false positives.

Consent

Explicit authorization language where the applicant agrees to the background check and release of records for employment screening purposes.

Search Scope

Specifies jurisdictions, timeframes, and record types to be checked, such as local arrest records, state repositories, and national criminal databases.

Requester Info

Employer or agency name, contact person, purpose of the check, and reference number to link results back to the hiring decision.

Disclosure

Pre-adverse and adverse action notice placeholders and any consumer disclosure text required under federal or state law.

Signature

Signature and date fields for the applicant plus witness or notary fields where state rules require additional authentication.

Step-by-Step: How to Complete the Employment Police Clearance Form

Follow this sequence to prepare and submit a correct form for background screening.

01

Gather IDs: Collect government-issued photo ID and any prior name documentation.
02

Enter details: Complete identity and contact fields accurately without abbreviations.
03

Review consent: Read and initial the consent and disclosure language carefully.
04

Sign and submit: Sign in the designated block and return to the requester or upload to the screening vendor.

How to Configure an Online Clearance Workflow

Configure these common settings when digitizing the form to ensure proper routing and authentication.

Field	Configuration
Identity Fields	Required fields with validation for DOB and ID formats
Consent Checkbox	Make required and display e-disclosure prior to signing
Authentication	Use email plus SMS OTP or KBA for higher assurance
Routing	Auto-send completed form to HR and screening vendor

Where Completed Forms Are Sent and Processed

Completed forms typically follow a clear path from applicant to screening and decision.

Applicant: Completes and signs the form, provides ID details
Employer/HR: Receives form and authorizes the background check
Screening Vendor: Runs searches and compiles results across repositories
Decision Record: Employer records clearance or adverse action steps

Digital Delivery and Signing Considerations

Decide authentication level, storage location, and integrations before accepting electronic signatures.

Authentication: Email link plus SMS OTP or knowledge-based checks
Storage: Encrypted cloud storage with access controls
Integrations: Connect to HRIS and background vendors

Use vendors that meet regulatory and data-protection standards for your industry and maintain an auditable trail of consent and delivery.

Timing, Deadlines, and Typical Processing Expectations

Understand candidate responsiveness and vendor timelines to set realistic processing expectations.

Form Submission Timing:

Provide the completed form when requested during pre-employment screening.

Vendor Turnaround:

Local checks complete in 1–7 business days; multi-jurisdiction checks take longer.

Adverse Action Timeline:

Allow time for pre-adverse notices and candidate response before final decisions.

I-9 and Payroll Alignment:

Coordinate clearance timing with I-9 completion and onboarding schedules.

Retention Trigger:

Retention obligations begin when the employer receives the report or completes onboarding.

Common Mistakes That Delay Clearance

Incomplete identity fields or mismatched names that prevent automated database matching and require manual review.
Unsigned or undated consent blocks that render the form invalid under ESIGN or state e-signature rules.
Providing P.O. boxes instead of physical addresses when a street address is required for jurisdictional checks.
Failing to follow state-specific witness or notary requirements where they are mandated for authenticity.

Penalties and Legal Risks of Incorrect Forms

Data Privacy Breach: Potential regulatory fines and remediation costs for mishandling sensitive records

I-9 Violations: Civil fines ranging from low hundreds to thousands per violation

Adverse Action Errors: Risk of discrimination claims if process lacks documented, consistent basis

Invalid Consent: Court may deem report inadmissible if consent form is defective

Background Check Delays: Operational costs and candidate loss from extended onboarding timelines

Incorrect Record Reliance: Hiring mistakes leading to liability in safety-sensitive positions

eSignature Vendor Comparison for Employment Police Clearance Forms

Comparison of core pricing and compliance features relevant to secure clearance forms; signNow appears first per vendor listing requirements.

	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 vendor	Varies by vendor	Varies by vendor	Varies by vendor
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 the Employment Police Clearance Form

Answers to common questions about completing, submitting, and authenticating clearance forms in hiring workflows.

Need help? Contact support

Can the form be signed electronically?
Yes. Under the ESIGN Act and UETA in most states, electronic signatures are valid for consent and release when intent and consent are documented and the record is retained.
What if names on ID and form differ?
Provide documenting paperwork such as a marriage certificate or court order for name change and include aliases on the form to ensure accurate record matching.
Is notarization always required?
Not universally. Notarization or witnesses are required in some states or for certain official clearances; check state rules or the requesting authority before notarizing.
How long do vendors keep screening records?
Retention varies by vendor and regulation; employers should require vendors to retain records for the employer's required retention period and provide audit access.
What happens if adverse information appears?
Follow pre-adverse and adverse action procedures, provide required notice to the applicant, and document the employer's decision process to reduce legal exposure.
Can a candidate withdraw consent after signing?
Candidates may withdraw consent, but employers should document withdrawal and understand it may prevent completion of screening required for hiring eligibility.

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