General Release Form For Background Checks And Consumer Reports printable pdf download

General Release Form For Background Checks And Consumer Reports

GENERAL RELEASE FORM FOR BACKGROUND CHECKS AND CONSUMER REPORTS

In connection with my application for employment, I understand that consumer reports or investigative

reports which may contain public record information may be requested or made on me including consumer

credit, criminal records, driving record, education, prior employer verification, worker’s compensation claims

and others. These reports will include experience along with reasons for termination of past employment.

Further, I understand that you will be requesting information from various Federal, State, Local, and other

agencies which contain my past activities.

I hereby authorize without reservation, any party or agency contacted by this employer to furnish the above-

mentioned information.

I have the right to make a request of CIC Applicant Background Checks, upon proper identification and the

payment of any authorized fees, for the information in its files on me at the time of my request.

I further authorize ongoing procurement of the above-mentioned reports at any time during my employment

(or contract).

Print your name ________________________________________________________________

Street Address _________________________________________________________________

City ____________________________________ State _________________ Zip ____________

Social Security Number _________________________________

Driver’s License State __________________ License Number ___________________________

FOR IDENTIFICATION PURPOSES

Date of Birth

Month ________________ Day ________ Year _________ Race ___________ (optional)

Other or Former Names __________________________________________________________

Professional License: State ______________ Type ___________________ Number _________

Signature ______________________________________________ Date __________________

For Personnel Department Use Only

Arrange Interview

Yes

Remarks

INTERVIEWER

DATE

Date of Employment

Employed

Yes

Hourly Rate/

Job Title

Salary

Department

NAME

TITLE

DATE

General Release Form For Background Checks And Consumer Reports