Employment Pre-Employment Checks

EMPLOYMENT PRE-EMPLOYMENT CHECKS

This Employment Pre-Employment Checks form documents the candidate's identification and authorizations necessary for employment-related background investigations. Completion and signature constitute the applicant's informed consent to the scope of checks requested below and the release of records as described in the Authorization and Release section.

Personal Information

Social Security Number (last 4 digits):    Date of Birth:

Position Information

Proposed Start Date:

Employment Type: Full-time Part-time Temporary Contractor

Pre-Employment Checks Requested

The employer requests authorization to perform the following checks as relevant to the position. Applicant must indicate authorization below and initial any checks that are specifically required by the employer.

Employment verification (prior employers, job title, dates, eligibility for rehire)

Criminal background check (state, county, national as permitted)

Drug and controlled substances screening

Credit history report (only if job-related and permitted)

Education credential verification

Professional license/certification verification

Motor vehicle record check (for driving positions)

Social media and public internet presence review (job-related only)

Applicant Authorization to Conduct Checks: I authorize the employer and its authorized agents to obtain the checks indicated above and to verify all information provided to the employer.

Employment History

Employer 1

Employment Dates From:    To:

Employer 2

Employment Dates From:    To:

Education

Graduation/Completion Date:

References

Reference 1

Reference 2

Reference 3

Legal Disclosures

At-Will Employment: I understand that, unless otherwise defined by a separate written agreement signed by an authorized representative of the employer, my employment is at-will. Either I or the employer may terminate the employment relationship at any time, with or without cause or notice.

Equal Employment Opportunity: The employer is an equal opportunity employer. Employment decisions will be made without regard to race, color, religion, sex, national origin, age, disability, or any other status protected by applicable law.

Applicant Certification and Authorization

I certify that all information I have provided on this form and in any related documentation is true, complete, and correct to the best of my knowledge. I understand that any omission, misrepresentation, or falsification may result in withdrawal of any offer of employment or termination of employment if discovered after hire.

Authorization and Release: I authorize the employer, its agents and representatives to contact my former employers, educational institutions, licensing authorities, law enforcement agencies, consumer reporting agencies, and other third parties to obtain and verify information regarding my background, education, employment history, professional licenses, motor vehicle records, criminal history, credit history (where job-related), and any other information relevant to the employer's decision. I authorize those persons and entities to release such information to the employer and its agents. I hereby release from liability the employer and all persons and entities providing or collecting such information.

I understand that the results of background checks may be used to determine my suitability for the position, and that the employer will comply with applicable laws governing the use of such information. I further acknowledge that a conditional offer may be contingent upon satisfactory completion of the checks indicated above and any required testing.

I certify that the foregoing statements are true and correct and that I have read and understand this authorization and release.

I consent to the use of my electronic signature and acknowledge that an electronic signature applied on this form is the legal equivalent of my handwritten signature.

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