Background Check Release Form-Employment (Page 2 of 2) in pdf

BACKGROUND CHECK RELEASE FORM-Employment – Page 2

Use this form if education verification, employment verification/investigation or reference checks are required.

College: 1 - _________________________ City, ST_________________ Attendance dates: ____________ Degree: ____________

College: 2 - _________________________ City, ST_________________ Attendance dates: ____________ Degree: ____________

High school - _________________________ City, ST_________________ Attendance dates: ____________ Year Graduate:________

GED State issued: - _________________________ Test Location:____________________________ Year received______________

NOTE: INABILITY TO IDENTIFY YOUR CURRENT OR PRIOR EMPLOYMENT CAN CANCEL OR DELAY PROCESS. BE VERY THOROUGH IN THIS PART.

1. Employer Name: ____________________________ Phone number: ___________________ Address, City, State______________________________

Position: __________________________________ Dates worked: From ______ to ________ Reason left? ___________________________________

Supervisor’s name___________________________ Co-workers name: _______________________________

2. Employer Name: ____________________________ Phone number: ___________________ Address, City, State______________________________

Position: __________________________________ Dates worked: From ______ to ________ Reason left? ___________________________________

Supervisor’s name___________________________ Co-workers name: _______________________________

3. Employer Name: ____________________________ Phone number: ___________________ Address, City, State______________________________

Position: __________________________________ Dates worked: From ______ to ________ Reason left? ___________________________________

Supervisor’s name___________________________ Co-workers name: _______________________________

Check here ____, if we are not free to contact your present employer at this time.

References:

1. Name:

Phone #:

Email address:

2. Name:

Phone #:

Email address:

3. Name:

Phone #:

Email address:

Background Check Release Form-Employment Page 2