I understand that the background check is being conducted to evaluate my eligibility for employment, including but not limited to assessing my qualifications, character, and suitability for the position for which I have applied.
Full Name: | |
Date of Birth: | |
Social Security Number: | |
Current Address: |
Employer: | Role: | ||
Start Date: | End Date: |
By signing below, I voluntarily consent to the background check described above. I understand that this information will be used solely for the purpose of evaluating my application for employment. I release [Company Name], its agents, representatives, and any third-party organizations conducting the background check from any liability arising from the use or disclosure of the information obtained during the background check.
I understand that I have the right to request a copy of any background check report that is conducted. If I wish to receive a copy, I must make a written request to [Company Name] within a reasonable time.
In the event that adverse action is taken based on information obtained in the background check, I will be provided with a copy of the report and a summary of my rights under the Fair Credit Reporting Act (FCRA). I will have an opportunity to dispute the accuracy of the report with the reporting agency.
I understand that this consent will remain in effect throughout the application process and, if I am hired, throughout my employment with [Company Name]. I may revoke this consent at any time by providing written notice to [Company Name].
I have read and understand the contents of this Background Check Consent Form, and I voluntarily authorize [Company Name] to conduct the background check as described herein. I understand that this consent is a condition of my application for employment.
Applicant's Full Name (Printed): [Your Name]
Applicant's Signature: _______________________
Notes: |
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