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Background Investigation Authorization Form

This document is a background investigation authorization form that informs the individual that a background check may be conducted as part of the screening process. It specifies that inquiries may be made to gather information about their character, lifestyle, reputation, and verifies information provided. The individual has a right to request the nature and scope of any report produced. Personal information such as social security number, date of birth, driver's license, and addresses for the past 7 years are requested to process the investigation. The individual authorizes the background check and releases all parties providing information from liability.

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jeong Lee
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343 views1 page

Background Investigation Authorization Form

This document is a background investigation authorization form that informs the individual that a background check may be conducted as part of the screening process. It specifies that inquiries may be made to gather information about their character, lifestyle, reputation, and verifies information provided. The individual has a right to request the nature and scope of any report produced. Personal information such as social security number, date of birth, driver's license, and addresses for the past 7 years are requested to process the investigation. The individual authorizes the background check and releases all parties providing information from liability.

Uploaded by

jeong Lee
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Background Investigation Authorization Form

(Please Read Carefully Before Signing)

The Fair Credit Reporting Act (Amended 1997) has stipulation that we inform you that a background investigation
may be processed as part of our screening and selection process. This investigation may include inquiries to gather
legal information regarding your personal characteristics, mode of living, character and general reputation. This
information, if gathered, is used to verify that specific information that you provided on an application, resume or
during the interview process. Upon your written request, within a reasonable timeframe, the nature and scope of the
report, if one is made, will be provided. In addition, if a report is processed, you have a right to request a copy of the
report from the consumer reporting agency that provided same report.

The items of personal information requested below are needed to process your background investigation. This
information is intended solely for that purpose and will not be used in a discriminatory manner by the parties noted
below in the making of appropriate business decisions.

Social Security # _______ - ____ - _______ Your Date of Birth _____ - _____ - ______
(Month,Day,Year)
Driver’s License # ____________________________ State of Issue _____

List all your addresses for the past seven (7) years, starting with most recent: (Must include present address)
Street Zip From To
Address City State County Code Mo./Yr. Mo./Yr.
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________

Have you ever been convicted of a crime (Other than minor traffic offenses)? Yes__ No__

If Yes, Please Explain Charges: (Use an additional sheet of paper if necessary)_____________________________


______________________________________________________________________________________________

What State, What County and What Year did these convictions occur?____________________________________

Other names you have used, including maiden names and the date(s) your name(s) changed:
______________________________________________________________________________________________

I authorize and/or Oxford Document Management and their


agents to investigate my background as it pertains to employment, appointment or volunteering considerations. This
may include information contained in public records which could include credit history, criminal files at the county,
state and federal jurisdiction levels, motor vehicle records and investigations of employment history and performance
and educational credentials. I hereby release all persons, companies or corporations furnishing such information
from liability and responsibility. A photo static copy of this document can be substituted for the original. This
document shall be valid for a period of 1 (one) year from the date of my signature.

Signature of Potential Employee________________________________________ Date: ____/____/____

Printed Full Name of Applicant____________________________________________________________________

(MN/CA residents only): Do you wish to receive a copy of your consumer report? Yes____ No____

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