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FORM 24
Background Verification Authorization
The purpose of this form is to notify you that a Consumer Background Report will be conducted on you in the course of employment with (your company name) or any of its subsidiary or affiliated companies.
I understand that this report may be used to make decisions about my employment, including one or more of the following: hiring, firing, promotion, and reassignment. According to the Fair Credit Reporting Act (FCRA), I am entitled to know if employment will be and is ultimately denied or any other adverse action taken because of information obtained by my prospective employer from a consumer-reporting agency. If so, I will be advised by this employer, provided a copy of the report and be given the name of the agency or source of this information to dispute the information contained therein.
The investigation will be conducted by
www.backgroundchecks.com
12770 Coit Rd
Suite 1150
Dallas, TX 75251
US
Phone: 1-866-300-8524
Fax: 469-791-9237
I understand that
(your company name) has asked this agency to prepare a report that will include a full criminal records search, social security number check, a driving record check if applicable, and verification of past employment and education. I hereby authorize any and all public and private record holders of such information to release same to www.backgroundchecks.com
I understand that I have the right to inspect the report at the investigative agency's offices during normal business hours and after reasonable notice to the agency. I can also inspect the report by certified mail or by telephone. I must show proper identification and pay for any costs involved with the inspection. I have the right to be accompanied by one other person who must also show proper identification. The investigative agency will explain any of the information in the report and will provide a written explanation of any coded information. I also understand that I may request additional information about the nature and scope of the investigation and a summary of my rights under the consumer reporting laws.
I release both (your company name) and www.backgroundchecks.com , and all their predecessors, successors, partners, heirs, representatives, assigns, agents, employees, shareholders, officers, directors, attorneys, insurers, associates, subsidiaries, divisions and affiliated and/or sibling corporations, and all others from all claims, liability, and damages that may result from negligently investigating, furnishing, communicating, reviewing, or evaluating information pursuant to this investigation and from the use of the report. This release means I am waiving claims for negligence, misrepresentation, emotional distress, invasion of privacy, interference with prospective business relations or contract, breach of contract, and any other negligent act. I expressly intend that this release is as broad and inclusive as is permitted by law. Also, if any portion of this release is held invalid, the balance will continue in full legal force.
I've read this Notice, Authorization and Liability Release and understand and agree with each of its terms. I voluntarily authorize www.backgroundchecks.com to conduct an investigation of me and to provide a report on me to (your company name). I further authorize a email or telephone facsimile or (FAX) or photographic copy of this release to be as valid as the original.
I understand that any offer of employment from (your company name) will be contingent upon the results of a number of factors including, but not limited to, this background check.
Please Type:
First Name: Middle:
Last Name: Other names used:
Drivers License Number: State of issue:
Social Security Number: Country:
Current address:
Number Street Apt.# City State Zip
Date of Birth:
Name of Applicant (print):_______________________________________
Applicant's Signature:_____________________________Date:
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