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    Background Check Authorization-1

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    Lise Desormeaux
    This document is a pre-employment screening authorization form. It requests the applicant's personal information such as name, address history, and identification details. It authorizes the employer to conduct a background check on the applicant through an outside agency. This may include obtaining a consumer report and investigative consumer report, checking the applicant's driving record, criminal history, employment references, and more. The form notes the applicant's rights to request additional disclosures and inspect any files related to the background check under relevant laws such as the Fair Credit Reporting Act.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Background Check Authorization-1

    Uploaded by

    Lise Desormeaux
    156 views2 pages
    This document is a pre-employment screening authorization form. It requests the applicant's personal information such as name, address history, and identification details. It authorizes the employer to conduct a background check on the applicant through an outside agency. This may include obtaining a consumer report and investigative consumer report, checking the applicant's driving record, criminal history, employment references, and more. The form notes the applicant's rights to request additional disclosures and inspect any files related to the background check under relevant laws such as the Fair Credit Reporting Act.

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    This document is a pre-employment screening authorization form. It requests the applicant's personal information such as name, address history, and identification details. It authorizes the employer to conduct a background check on the applicant through an outside agency. This may include obtaining a consumer report and investigative consumer report, checking the applicant's driving record, criminal history, employment references, and more. The form notes the applicant's rights to request additional disclosures and inspect any files related to the background check under relevant laws such as the Fair Credit Reporting Act.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    156 views2 pages

    Background Check Authorization-1

    Uploaded by

    Lise Desormeaux
    This document is a pre-employment screening authorization form. It requests the applicant's personal information such as name, address history, and identification details. It authorizes the employer to conduct a background check on the applicant through an outside agency. This may include obtaining a consumer report and investigative consumer report, checking the applicant's driving record, criminal history, employment references, and more. The form notes the applicant's rights to request additional disclosures and inspect any files related to the background check under relevant laws such as the Fair Credit Reporting Act.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    of 2

    Pre-Employment Screening Authorization

    APPLICANTs NAME & CONTACT INFORMATION: ___________________________________ (_____) _______-____________ Please Print
    SOCIAL SECURITY NUMBER Middle DATE OF NAME CHANGE

    APPLICANT DATA: Courts and other entities require the following information for identification when checking public records. It is confidential and used for identification only.
    LEGAL NAME as shown on the applicants Social Security Card (Required) Last First FORMER NAMES any other names used (Required) Last First NAME as it appears on drivers license (Required) Last First POSITION HELD Title

    Middle

    Middle

    LICENSE or ID NUMBER State of Issue: DATE OF BIRTH

    Department

    APPLICANT RESIDENCE HISTORY: Provide Addresses for the past 7 years, with current address first (include PO Box, Apt. #, etc), then list former addresses)
    Street Street Street Street City City City City State State State State Zip Code Zip Code Zip Code Zip Code Years Years Years Years

    DISCLOSURE, AUTHORIZATION AND CONSENT As a matter of current policy, background check reports are obtained on current employees. This policy is a business necessity that protects everyone by helping to promote a safe and profitable workplace. All inquiries are limited to information that affects job performance and the workplace. It is conducted in accordance with applicable federal and state laws including the Fair Credit Reporting Act (FCRA). The screening will be conducted by an outside agency - Employment Screening Resources. As a result, TriNet may obtain a Consumer Report and/or an Investigative Consumer report on you as an applicant or during employment. 1. Consumer Report: A Consumer Report consists of information deemed to have a bearing on job performance, and may include information from public and private sources, public records, former employers and references. The scope of the report may include information concerning your driving record, civil and criminal court records, credit, workers compensation record, education, credentials, identity, past addresses, social security number, previous employment and personal references. 2. Investigative Consumer Report: A Consumer Report may also include reference checks from former employers or references provided by the employee. Any reference check is strictly limited to job related information. These are known as an investigative consumer report. This type of report is legally defined as a report based upon interviews that may contain information relating to your character, general reputation, personal characteristics or mode of living. You have the right to request additional disclosures of the nature and scope of the investigation and a statement of your rights. To receive this information or to inspect any files concerning such a report, you may contact TriNet or Employment Screening Resources at 888.999.4474, or at 1620 Grant Ave., Suite 7, Novato, CA 94945. 3. Notice to Applicants: Under the Fair Credit Reporting Act, should an employer rely upon a consumer report for an adverse action, before taking that action you will be provided with a copy of the consumer report and a summary of your rights. 4. California Applicants Only: Any report concerning a consumer's character, general reputation, personal characteristics or mode of living is defined as an Investigative Consumer Report. In addition to your rights under federal law, you have the following additional rights: you have the right to inspect ESR's files during normal business hours and on reasonable notice; the inspection may be in person, by having a copy of the file mailed to you, or by receiving a verbal summary by telephone if you provide proper identification and pay for any costs involved; you may be accompanied by one other person who must provide proper identification; and trained ESR personnel will explain any of the information in the report and will provide written explanation for any coded information. 5. California, Minnesota and Oklahoma Applicants Only: If you want to receive a free copy of any Consumer Report, Investigative Consumer Report or Credit Report on you that is requested, check here. Yes No I hereby consent and authorize TriNet and/or Employment Screening Resources (ESR) on the employers behalf, to prepare a report as defined above for employment purposes before employment or anytime after employment. I authorize and release individuals, companies, references, current and former employers, schools, credit bureaus, municipal, county, state and federal agencies and courts, to provide all information that is requested to the employer or ESR. I also agree that the report may be released to the employer where I perform my work. I agree that a copy or fax of this document shall be valid as an original and I certify that the facts and information on the form and in my resume and/or application are true and correct.
    NAME SIGNATURE DATE

    ESR 0605 JP F-CHR004

    PAGE 1

    Pre-Employment Screening Authorization


    TO BE COMPLETED BY TRINET CUSTOMER (required): REQUEST FOR EMPLOYEE BACKGROUND CHECK COUNTY OF RESIDENCE (only) CRIMINAL please designate: LAST THREE COUNTIES OR PAST 7 YEARS Other CREDIT REPORT MOTOR VEHICLE REPORT PROFESSIONAL LICENSE VERIFICATION SOCIAL SECURITY TRACE SPECIAL INSTRUCTIONS: EDUCATION highest College unless otherwise indicated Other ___________________________________________________ EMPLOYMENT past three employers unless otherwise indicated Past _______ years Other ___________________________________________________

    CHECK PREVIOUS NAMES FOR CRIMINAL SEARCHES (ADDITIONAL CHARGE PER COUNTY CHECKED)

    CUSTOMER APPROVAL -- CUSTOMERs NAME: ___________________________________ CUSTOMER CONTACTs NAME CUSTOMER CONTACTs SIGNATURE PHONE NUMBER DATE

    Note: If requesting education or employment verification, please fax resume and/or employment application.

    FAX THE COMPLETED FORM (WITH RESUME/APPLICATION) TO 1 (800) 448-7972

    0605 F-CHR004 PAGE 2

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