Job Application Authorization Form

Job Application Authorization Form

Applicant Name:     Position Applied For:

Employer Name:     Application Date:

WHEREAS

WHEREAS, Applicant has submitted an application to Employer for consideration for employment in the position identified above and has provided certain information and documents for Employer's review; and

WHEREAS, Employer requires Applicant's authorization to obtain and verify employment, education, criminal, consumer, motor vehicle, and other background information necessary to evaluate Applicant's qualifications for employment; and

WHEREAS, the parties wish to set forth the terms and scope of Applicant's authorization and related administrative terms.

AUTHORIZATION

By signing below, Applicant expressly authorizes Employer and its agents, representatives, and any third-party service providers retained by Employer to obtain, collect and review consumer reports, investigative consumer reports, background checks, and any other information concerning Applicant's employment history, education, criminal history, driving record, credit history (if relevant to the position), and references. Applicant also authorizes current and former employers, schools, law enforcement agencies, courts, and other persons or entities to release such information to Employer.

Applicant acknowledges that such information may be used for purposes of hiring, retention, assignment, promotion, and any other employment-related decisions and that Employer may retain a copy of this authorization in its personnel or application records.

Applicant consents to the release of information as described above: Yes

SCOPE OF WORK

PAYMENT TERMS

Applicant understands that certain verifications and background checks may incur administrative or processing fees. The party responsible for payment and payment schedule is set forth below.

TERM AND TERMINATION

This authorization is effective as of: and will expire on: .

Either party may terminate this authorization upon written notice to the other party. Notice must be provided at least days prior to termination, except that termination shall not affect the Employer's right to use information obtained prior to termination for lawful employment decisions.

CONFIDENTIALITY

Employer and any third-party service providers shall maintain as confidential all information obtained pursuant to this authorization, disclosing such information only to those within Employer who have a need to know for legitimate employment purposes, to prospective insurers, to legal counsel, or as otherwise required by law. Employer will implement reasonable administrative, technical, and physical safeguards to protect such information from unauthorized access or disclosure.

Notwithstanding the foregoing, Employer may disclose information when compelled by court order, subpoena, or other legal process, provided Employer gives Applicant notice of such disclosure if permitted by law.

REPRESENTATIONS AND WARRANTIES

Applicant represents and warrants that all information provided to Employer is true, complete and correct to the best of Applicant's knowledge. Applicant understands that material misrepresentations or omissions may be grounds for refusal to hire or for termination of employment if discovered after hire.

GOVERNING LAW

This Authorization Form shall be governed by and construed in accordance with the laws of the State of , without regard to conflict of law principles.

ENTIRE AGREEMENT

This Authorization Form constitutes the entire agreement between Applicant and Employer with respect to the subject matter hereof and supersedes all prior oral or written statements, representations, or agreements relating to authorization for background checks and verification. No amendment or modification of this Authorization Form shall be effective unless in writing and signed by both parties.

ADDITIONAL APPLICANT INFORMATION

ACKNOWLEDGMENT AND CERTIFICATION

By signing below, Applicant certifies under penalty of perjury that the information provided in or with the application is true and complete. Applicant acknowledges receipt of a copy of this Authorization Form and understands the scope of the authorizations granted herein.

Sign Now