Permission To Conduct Background Check printable pdf download

Ph: 1-888-YOU-VERIFY (968-8374) | Fax: 1-888-827-4468

E-mail:

PERMISSION TO CONDUCT BACKGROUND CHECK

I understand and agree that: The information supplied on this release form is true and correct, to the best of my

knowledge. The company has my authorization to thoroughly investigate my professional and personal history to

generate a background screening report. I understand that the background report may include, but is not limited

to, the following areas: Employment History, Education History, Credit History, Criminal History, Drug Testing,

Professional Licensing, Motor Vehicle Records, Social Media History, Residence History and References. A

background check will be conducted to verify the veracity of the information submitted and will be utilized to

develop information concerning my character, general reputation, personal characteristics, and mode of living. I

will hold no person liable for giving or receiving information in this investigation. I hereby authorize InfoCheckUSA,

LLC an agent of the Company to make a thorough background investigation of all information given by me to the

Company.

I release from liability all persons, companies, and corporations supplying that information.

Furthermore, I release and indemnify the Company and InfoCheckUSA, LLC against any liability that might result

from making such background checks. Upon Request, InfoCheckUSA, LLC will supply a copy of the completed

background report along with a copy of an individual’s rights under the Fair Credit Reporting Act. A copy of this

form is as valid as the original.

The following information is required for identification purposes when checking records. It is

confidential and will not be used for any other purpose.

Applicant’s Name:_______________________________________________________________

Applicant’s Date of Birth:___/___/___ Applicant’s SS No:_________-________-_____________

Drivers License No: _____________________________State Issued: _____________________

Address (Current): ______________________________________________________________

City:_____________________State:_______ County:_______________ Zip________________

Company Requesting Report: _________________________ Company Location (State): ______

Date of Request: ____/____/_____ Company Phone No:__________________________

For residents of California, Minnesota and Oklahoma: You will be provided with a free copy of any consumer

reports or investigative consumer reports on you if you check this box: □

Notice to New York Applicants: Under Article 25 Sec 380-g of the NY General Business Law, should a consumer

report received by an employer contain criminal conviction information, the employer must provide to the

applicant or employee who is the subject of the report, a printed or electronic copy of Article 23-A of the New York

Correction Law, which governs the employment of persons previously convicted of one or more criminal offenses.

Applicant Signature:____________________________________ Date: ___/___ /____

Permission To Conduct Background Check