BACKGROUND CHECK INFORMATION AND ORDERING FORM FOR EMPLOYMENTSCREENING
BACKGROUND CHECK DISCLOSURE AND RELEASE AUTHORIZATION FORM FOR EMPLOYMENT SCREENING
Background Screening Disclosure by the Individual for Employment PurposeI hereby authorize Verifitech and its designated agents and representatives to conduct to a comprehensive review of my background through an investigative method and the report to be generated for employment purpose. I understand that the scope of the investigative consumer report may include, but is not limited to, the following areas; Names and dates of previous current employment, work experience, Bureau of Workers Compensation / Claims, Criminal history records (from local, state, international and other law enforcement agencies records).
Authorization and ReleaseI, authorize the complete release of these records or data pertaining to me which an individual, company fir, corporation, institution, school or university, law enforcement or public agency may have. I authorize the full release of the information described above, without any reservation, throughout any duration of my employment at the company. I certify that all information provided below is true and accurate to the best of my knowledge. This authorization and consent shall be valid in original, facsimile (“fax”), or copy form.
The following information is required by law enforcement agencies and other entities for identification purposes when checking records. It is confidential and will not be used for any other purpose.Please PRINT LEGALLY: Print Full Name (First Middle Last) Maiden /AKA/Previous Name ( s)Aadhar Card # (if India) / Social Security # (SSN) (If U.S.A) / If PR of Other county; respective ID No.Date of Birth (MM/DD/YYY) (This will not affect hiring decision)1)Driver’s License # / 2)Passport # State of Issue Current AddressCity State zipcode Phone Number Email