Free Background Check Affidavit Template
Background Check Affidavit
I, [Your Name], in my capacity as [Your Title] at [Your Company Name], located at [Your Company Address], do hereby affirm the accuracy of the information provided by [Applicant's Name], hereinafter referred to as the "Applicant," in this Background Check Affidavit.
Applicant's Personal Information:
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Full Name: [Applicant's Name]
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Date of Birth: [Applicant's Birthdate]
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Social Security Number: [Applicant's SSN]
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Current Address: [Applicant's Address]
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Contact Number: [Applicant's Number]
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Email Address: [Applicant's Email]
Employment History:
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Company Name: [Employer 1]
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Address: [Employer Address]
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Position Held: [Your Position]
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Dates of Employment: [Start Date] to [End Date]
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Reason for Leaving: [Reason]
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Company Name: [Employer 2]
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Address: [Employer Address]
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Position Held: [Your Position]
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Dates of Employment: [Start Date] to [End Date]
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Reason for Leaving: [Reason]
Educational Background:
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School/College Name: [Institution Name]
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Address: [Institution Address]
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Degree Obtained: [Degree]
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Major/Field of Study: [Major/Field]
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Dates of Attendance: [Start Date] to [End Date]
Criminal History [if applicable]:
[List any criminal convictions.]
Driving Record [if applicable]:
[List any traffic violations, suspensions, or revocations of driver's license.]
References:
Professional Reference 1:
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Name: [Reference Name]
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Position: [Reference Position]
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Company/Organization: [Reference Company/Organization]
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Contact Information: [Reference Email]
Professional Reference 2:
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Name: [Reference Name]
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Position: [Reference Position]
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Company/Organization: [Reference Company/Organization]
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Contact Information: [Reference Email]
I hereby certify that the information provided by the Applicant in this Background Check Affidavit is true and accurate to the best of my knowledge. I understand that any false statements or omissions may result in disqualification from employment.
[Date]
Sworn to and subscribed before me this [Date] day of [Month], [Year].
[Your Company Seal]
