Background Check Authorization

Employment Background Authorization

Name:

First

Middle

Last

Maiden Name:

Other Name Used:

Social Security:

Phone

Current Name Layout

Driver License Number:

Driver License State:

Other Driver License Number:

Other Driver License State:

FOR IDENTIFICATION PURPOSES ONLY________________

Date of Birth:

Resident Address within 7-Years___________________________

Current Address:

Address Line 1

Address Line 2

City

State

Zip Code

Previous Address:

Address Line 1

Address Line 2

City

State

Zip Code

2nd Previous Address:

Address Line 1

Address Line 2

City

State

Zip Code

3rd Previous Address:

Address Line 1

Address Line 2

City

State

Zip Code

4th Previous Address

Address Line 1

Address Line 2

City

State

Zip Code

5th Previous Address

Address Line 1

Address Line 2

City

State

Zip Code

Pursuant to the federal Fair Credit Reporting Act, I hereby authorize Pro Team Janitors LLC. and its designated agents and representatives to conduct a comprehensive review of my background through a consumer report and/or an investigative consumer report to be generated for employment, promotion, reassignment or retention as an employee. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: verification of Social Security number; current and previous residences; employment history, including all personnel files; education; references; credit history and reports; criminal history, including records from any criminal justice agency in any or all federal, state or county jurisdictions; birth records; motor vehicle records, including traffic citations and registration; and any other public records.

Type Your Name Here

authorize the complete release of these records or data about me that an individual, company, firm, corporation or public agency may have. I hereby authorize and request any present or former employer, school, police department, financial institution or other persons having personal knowledge of me to furnish [Company Name] or its designated agents with any information in their possession regarding me in connection with an employment application. I authorize a photocopy of this authorization to be accepted with the same authority as the original.
I understand that, pursuant to the federal Fair Credit Reporting Act, if any adverse action is to be taken based upon the consumer report, a copy of the report and a summary of the consumer’s rights will be provided to me.

I understand that, pursuant to the federal Fair Credit Reporting Act, if any adverse action is to be taken based upon the consumer report, a copy of the report and a summary of the consumer’s rights will be provided to me.

Digital Signature

I certify that my digital signature for this Background Check Authorization Form is a legally binding equivalent of a traditional handwritten signature.

Date:

Employment Background Authorization

FOR IDENTIFICATION PURPOSES ONLY________________

Resident Address within 7-Years___________________________

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