HR Background Review

HR BACKGROUND REVIEW

This HR Background Review form documents applicant identifying information, authorizations, the scope of background screening ordered, results received, HR analysis and final disposition. Completion of this form and associated attachments is required prior to final hiring determinations when pre‑employment screening is applicable.

Personal Information

Other names used:    Date of Birth:    SSN (last 4):

Phone:    Email:

Position Information

Anticipated Start Date:    Proposed Salary:

Employment History (Most Recent)

Title:    From:    To:

Employment History (Previous)

Title:    From:    To:

Education

Graduation Date:    Major / Field:

References

Phone:    Email:    Relationship:

Phone:    Email:    Relationship:

Phone:    Email:    Relationship:

Background Screening Ordered

Criminal history / national & state searches

Employment verification

Education verification

Motor vehicle record (MVR)

Drug screening

Credit check (position contingent)

Screening Results and HR Analysis

Criminal History Result: Cleared Flagged Pending    Date Completed:

Employment Verification Result: Cleared Flagged Pending    Date Completed:

Hire Conditional hire (conditions noted) Do not hire Pending further review

Adverse Action Procedure (If Applicable)

If a decision not to hire or a conditional hire based on consumer report information is contemplated, HR must comply with the required pre‑adverse and final adverse action procedures. Pre‑adverse notice delivered: Yes No    Date Provided:

Legal Statements and Applicant Authorizations

At‑Will Employment: Nothing in this form, any conditional offer or any communication shall be construed to alter the at‑will employment relationship. Either the applicant or the employer may terminate employment at any time, with or without cause or notice, unless a separate written contract signed by authorized representatives states otherwise.

Equal Opportunity: The employer is an equal opportunity workplace. Screening and hiring decisions are made without regard to protected characteristics, except as required by applicable law or bona fide occupational qualifications.

Authorization to Obtain Consumer Reports and Verifications: I hereby authorize the employer and its agents to obtain consumer reports, criminal history, driving records, employment and education verifications, and other investigative reports for employment purposes. I acknowledge receipt of any consumer notice required by law prior to ordering such reports. I authorize current and former employers, educational institutions, references, and other entities to release information to the employer and its agents. I release those parties from all liability arising from the release of such information.

Applicant Certification: I certify that the information I have provided in support of my application and for the purpose of background screening is true and complete. I understand that falsification, omission, or misrepresentation of information may disqualify me from employment or lead to disciplinary action, up to and including termination.

HR Reviewer

Review Date:    Final Decision Reference #:

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