Nhec - Authorization Form For Criminal Background Check

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Authorization Form for Criminal Background Check
In connection with my application for a seat on the Board of Directors of New Hampshire Electric
Cooperative, Inc. (NHEC), I understand that criminal background inquiries are to be made on myself.
Further, I understand that NHEC will be requesting this information from various Federal, State, and
other agencies which maintain such records.
I authorize without reservation, any party or agency contacted by NHEC to furnish this above
mentioned information.
I hereby consent to NHEC obtaining the above information from First Advantage and/or any of their
licensed agents. I understand to aid in the proper identification of my file or records the following
information, as well as other information, is necessary.
Print your Name:
Street Address:
Social Security Number:
Drivers License State:
Drivers License Number:
The following is for identification purposes only to perform the background check:
Date of Birth (MM/DD/YYYY):
Gender (M or F):
Other for Former Names:
Professional License:


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Parent category: Legal