Adoption Applicant Background Consent Form

Applicant Information

Full Name Date of Birth Current Address Phone Number Email Address

Consent Statement

I authorize the adoption agency or its representatives to obtain background checks, including but not limited to criminal, financial, and employment history, as part of the adoption application process. I understand this information will be used solely for the purpose of evaluating my eligibility to adopt.

Other Names (if any, e.g., maiden or previous legal names) Previous Addresses (last 5 years)

Other Adults Living in the Home

Applicant Signature Date

Co-Applicant Signature (if applicable) Date