Background Check Affidavit

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:

  • Full Name: [Applicant's Name]

  • Date of Birth: [Applicant's Birthdate]

  • Social Security Number: [Applicant's SSN]

  • Current Address: [Applicant's Address]

  • Contact Number: [Applicant's Number]

  • Email Address: [Applicant's Email]

Employment History:

  • Company Name: [Employer 1]

  • Address: [Employer Address]

  • Position Held: [Your Position]

  • Dates of Employment: [Start Date] to [End Date]

  • Reason for Leaving: [Reason]

  • Company Name: [Employer 2]

  • Address: [Employer Address]

  • Position Held: [Your Position]

  • Dates of Employment: [Start Date] to [End Date]

  • Reason for Leaving: [Reason]

Educational Background:

  • School/College Name: [Institution Name]

  • Address: [Institution Address]

  • Degree Obtained: [Degree]

  • Major/Field of Study: [Major/Field]

  • 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:

  • Name: [Reference Name]

  • Position: [Reference Position]

  • Company/Organization: [Reference Company/Organization]

  • Contact Information: [Reference Email]

Professional Reference 2:

  • Name: [Reference Name]

  • Position: [Reference Position]

  • Company/Organization: [Reference Company/Organization]

  • 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]

Affidavit Templates @ Template.net