Background Check Consent and Release

Background Check Consent and Release

Please complete this form to authorize a background check and provide your personal information.
Full Name

First NameLast Name
Alias or Also Known As
Social Security Number
Current Address
Length of Time at This Address
Previous Address (if less than three years at current address)
Date of Birth

MonthDayYear
Date
I am the person named above and the information is truthful. My signature on this form grants Lending Hands Home Care LLC to run an initial criminal background check as well as any subsequent criminal background checks deemed necessary throughout the length of my employment. I understand that certain findings will restrict my ability to work in some positions.
Signature
Date of Signature

MonthDayYear
Date
Should be Empty: