Journalist Background Check Authorization

Full Name
Date of Birth
Address
Email
Phone
Media Organization
Position/Title

Authorization

I authorize the to conduct a background check in connection with my role as a journalist. This may include verification of my identity, credentials, prior employment, and any other relevant information.
I certify that the information provided is true and complete.
I understand that my consent is voluntary and I may withdraw it at any time by notifying .
Signature
Date