ZJAD Background Investigation Consent

Background Investigation Consent Form
I, {name} , hereby authorize Zucker Jewish Academy of Dallas and/or its agents to make an independent investigation of my background, references, character, past employment, education, credit history, criminal or police records for the purpose of confirming the information contained on my Application and /or obtaining other information which may be material to my qualifications for employment now and, if applicable, during the tenure of my employment with Zucker Jewish Academy of Dallas. I release Zucker Jewish Academy of Dallas and /or its agents and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims or lawsuits in regard to the information obtained from any and all of the above referenced sources used. The following is my true and complete legal name and all information is true and correct to the best of my knowledge:
Name

First NameLast Name
Maiden Name or Other Names Used
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County
How long have you lived at this address?
Date of Birth

MonthDayYear
Date
Social Security Number
Drivers License Number
State of License
Email Address
example@example.com
Phone Number
Format: (000) 000-0000.

NOTE: If you have resided at your present address for less than 5 years, provide all addresses (including county)outside of Texas during the past 5 years:

Rows	Address	City/State/ZIP	County
1
2
3

Signature
Date

MonthDayYear
Date
*NOTE: The above information is required every five years for background investigation purposes only. Zucker Jewish Academy of Dallas is an Equal Opportunity Employer, and does not discriminate on the basis of gender, race, national origin, age, disability, or any other legally protected class applicable to this institution.
Should be Empty:

Background Investigation Consent Form