Employee Background Check (Page 2 of 2) in pdf

Employee Background Check Page 2

Middle Name: __________________________________________________________________

Phone Number: __________________________________Email: _________________________

Social Security: _________________________________________________________________

Driver’s License: _____________________________________________State:______________

Permanent Address: _____________________________________________________________

City: ______________________________________________State: ______ Zip: _____________

Length of Time:_________________________

Please List Addresses For The Last Seven Years:

Address: _____________________________________________________________

City: ______________________________________________State: ______ Zip: _____________

Dates: ____/____/______ - ____/____/______

Address: _____________________________________________________________

City: ______________________________________________State: ______ Zip: _____________

Dates: ____/____/______ - ____/____/______

Address: _____________________________________________________________

City: ______________________________________________State: ______ Zip: _____________

Dates: ____/____/______ - ____/____/______

I hereby authorize all corporations, former employers, credit agencies, educational institutions,

law enforcement agencies, city, state, county, and federal courts, military services, and persons

to release information they may have about me to the person or company with which this form

has been filed. This releases the above mentioned parties from any liability and responsibility

for collecting the above information.

______________________________________________________________________________

Signature of Applicant

Date

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Employee Background Check Page 2