Employment Security Prescreen

Employment Security Prescreen

Personal Information

Position Information

Employment History (Most Recent)

Employment History (Previous)

Education

Graduation Date:

References (Professional)

Security, Criminal History & Foreign Contacts

Have you ever been convicted of a felony or misdemeanor (excluding minor traffic offenses)?  Yes No

Have you ever been terminated for cause, disciplined for misconduct, or resigned while under investigation?  Yes No

Do you have any foreign national contacts, foreign employment, foreign financial interests, or foreign travel in the past seven years that could be relevant to a security review?  Yes No

Authorizations and Disclosures

I authorize the company and its designated agents to obtain and verify all information provided on this prescreen, including but not limited to employment history, education, criminal history, motor vehicle records, credit reports where job-relevant, and any other public or private records. I further authorize prior employers, educational institutions, law enforcement agencies, and personal references to release such information to the company.

I understand that this prescreen may include drug and alcohol testing and fingerprinting where required by position or law, and that a conditional offer of employment may be rescinded based on the results of these checks. I release the company and all providers from liability for claims arising from the collection, investigation, or reporting of information obtained in connection with this prescreen, provided such actions are performed in conformance with applicable law.

By checking the box below I provide specific authorization:

I authorize background checks, reference checks, education verification, motor vehicle records checks, credit checks if job-related, and drug testing as required.

Employment Policies & Applicant Certification

I acknowledge that if hired, my employment will be on an at-will basis unless an express written agreement signed by an authorized company representative states otherwise. The company is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, or other protected status where applicable.

I certify that all information provided on this prescreen is true, complete, and correct to the best of my knowledge. I understand that falsification, omission, or misrepresentation of information may result in denial of employment or termination if discovered after hire. I consent to verification of any statements contained herein and understand that additional documentation may be requested.

Acknowledgment of Rights & Penalties

I understand that certain positions may require a security clearance or other suitability determinations. Providing false statements or failing to disclose required information for security purposes may subject me to disciplinary action, up to and including termination, and may be subject to criminal penalties under applicable law.

I further understand that receipt of information provided by third parties will be handled in accordance with applicable law and company policy. I may be required to sign additional release forms to complete background checks for specific roles.

Applicant Certification & Signature

I certify under penalty of perjury that the foregoing is true and correct. I understand that this prescreen is not an employment agreement and does not alter the at-will nature of employment.

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