Employee Background Check Form
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Note to Hiring Manager: Before making an offer of employment in any position you are required to have a criminal background check completed on your final candidate. Some positions require additional screening. The Employment office will contact you as soon as the background check is complete.
Date: ____/____/______
Hiring Manager Name:
________________________________
Department:
________________________________
Phone:
________________________________
Cell:
________________________________
Hiring Manager Signature:
________________________________
Type of Background Check:
[__] Criminal
[__] Employment
[__] Worker Compensation
[__] Motor Vehicle
[__] Credit Check
[__] Education
Applicant Information:
Position Applied For:
________________________________
Date of Birth: ____/____/______
Last Name:
________________________________
First Name:
________________________________
Middle Name:
________________________________
Phone Number:
________________________________
Email:
________________________________
Social Security: _________________
Drivers License: ________ State: ____
Permanent Address: _______________
City: __________ State: ___ Zip: ____
Length of Time:___________________
Please List Addresses For The Last Seven Years:
Address: _________________________
City: __________ State: ___ Zip: ____
Dates: ___ /____ /___ - ___ /___ /___
Address: _________________________
City: __________ State: ___ Zip: ____
Dates: ___ /____ /___ - ___ /___ /___
Address: _________________________
City: __________ State: ___ Zip: ____
Dates: ___ /____ /___ - ___ /___ /___
I hereby authorize all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, city, state, county, and federal courts, military services, and persons to release information they may have about me to the person or company with which this form has been filed. This releases the above mentioned parties from any liability and responsibility for collecting the above information.
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Signature of Applicant
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