Mda Director Position Background Check Consent Form

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As part of the hiring process, you should be aware that the Michigan Department of
Agriculture will conduct a background screening, which will include a Michigan State
Police LIEN check. All new state employees must also pass a drug test as a condition
of employment. We have the right to refuse or terminate employment based upon
failure to successfully pass a background screening or drug test.
This information is confidential. Disclosure of confidential information is protected by
the Federal Privacy Act.
I have read the above paragraph and fully understand it. I hereby consent to allow the
Michigan Department of Agriculture to conduct a background check.
Name _____________________________________________Birth Date___________
Drivers Lic. #______________________________Social Sec. #__________________
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Parent category: Legal