Please note that a signed release must be obtained from the applicant or employee before a background check can be ordered.
Please also note that this and all other drug screening, driving record and state release authorization forms are available in a PDF format file to our Automated Employment Screening Clients. These forms may be e-mailed to the applicants and easily completed online.
Background Check Authorization Form
Authorization To Perform a Criminal Background Check
I (Name)__________________________________,(Date)______________, authorize the requesting employer name________________________and National Employment Screening, LLC. to obtain consumer reports and/or investigative consumer reports regarding me from time to time for employment purposes throughout the time of employment. In compliance with the Fair Credit Reporting Act, as amended by the Consumer Credit Reporting Reform Act of 2003, National Employment Screening, LLC. needs my authorization to obtain such a report.
To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all drug screening and background information requested by National Employment Screening, LLC., or the Company itself. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original.
New York applicants only: Upon request, you will be informed whether or not a consumer report was requested by the Company, and if such report was requested, informed of the name and address of the consumer reporting agency that furnished the report. You have the right to inspect and receive a copy of any investigative consumer report requested by the Company by contacting the consumer reporting agency identified above directly. By signing below, you acknowledge receipt of Article 23-A of the New York Correction Law.
Washington State applicants only: You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act.
Minnesota and Oklahoma applicants only:
I acknowledge that I understand that I will have access to my completed report by logging back in to this applicant screening system any time within the next 60 days.
California applicants only:
Under California Civil Code section 1786.22, you are entitled to find out what is in the CRA’s file on you with proper identification, as follows:
In person, by visual inspection of your file during normal business hours and on reasonable notice. You also may request a copy of the information in person. The CRA may not charge you more than the actual copying costs for providing you with a copy of your file.
A summary of all information contained in the CRA file on you that is required to be provided by the California Civil Code will be provided to you via telephone, if you have made a written request, with proper identification, for telephone disclosure, and the toll charge, if any, for the telephone call is prepaid by or charged directly to you.
By requesting a copy be sent to a specified addressee by certified mail. CRAs complying with requests for certified mailings shall not be liable for disclosures to third parties caused by mishandling of mail after such mailings leave the CRAs.
I ALSO CERTIFY THAT I HAVE RECEIVED A COPY OF “A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT” and have read and understand the documents ***
I (applicant’s Name)__________________________________,(Date)______________,
Also, available at https://www.consumer.ftc.gov/articles/pdf-0096-fair-credit-reporting-act.pdf
Our Automated Employment Screening provides an applicant controlled process that allows
FCRA compliant background check forms, including Electronic Chain-Of-custody forms
and releases to be completed online by the applicant.
We provide several short videos to easily acquaint you with the system.
This makes the background check process fast and easy.
Please Click or call for more information.
None of the information contained in this web site should be construed as legal advice.
All forms, policies, information and procedures should be reviewed by your legal counsel before being used in any way.