I hereby authorize the investigation of all statements contained in my employment application for employment purposes. I authorize the employer to make any inquiries regarding my character, general reputation, and former employment and release all parties from all liability for any damage that may result from furnishing this information.

Applicant Information

Full Name

Date of Birth

Social Security Number

Phone Number

Current Address

Disclosure and Authorization

I understand that, as a condition of employment, the company may conduct a background check, which may include criminal record, credit report, and employment verification as permitted by law. I hereby authorize the procurement of such report(s) and understand that this authorization will remain on file and will serve as ongoing authorization for such reports as long as I am employed.

Applicant Signature

Date

Pre-Employment Background Check Authorization

Applicant Information

Disclosure and Authorization