CONFIDENTIAL
Background Check Authorization
Participant's Information:
Former Name(s) and Dates Used:
Current Address Since:
Previous Address From:
Social Security Number:
DOB:
Telephone Number:
Drivers License Number/State:
The information contained in this application is correct to the best of my knowledge.
I hereby authorize
and its designated agents and
representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment and/or volunteer purposes. I understand that the scope of the consumer report/ investigative consumer report may include, but is not limited to the following areas: verification of social security number; credit reports, current and previous residences; employment history, education background, character references; drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions;driving records, birth records, and any other public records.
Date:
Signature:
FOSTERING NEW BEGINNINGS