Records & Authorization
Consent to Background Check
Authorization and consent for conducting a background check on an applicant. Single signer (applicant).
Document Preview
# Consent to Background Check **Date:** ___________ ## Applicant Information **Full Legal Name:** ___________ **Date of Birth:** ___________ **Social Security Number (last 4 digits):** ___________ **Current Address:** ___________ **Phone Number:** ___________ **Email Address:** ___________ ## Requesting Organization **Organization Name:** ___________ **Purpose of Background Check:** ___________ ## Authorization and Consent I, the undersigned, hereby authorize the Organization and its designated agents to conduct a background investigation as part of the above-described process. ### Scope of Investigation **Investigation Type:** ___________ The investigation may include but is not limited to: (a) Criminal records (federal, state, and county courts) (b) Sex offender registries (c) Employment history verification
Fields (14)
consent date
date · required
applicant name
text · required
date of birth
date · required
ssn last4
text · required
current address
textarea · required
phone
text · required
email
text · required
organization name
text · required
purpose
select · required
scope
select · required
state notices
select · required
consent duration
select · required
governing state
select · required
applicant signer name
text · required
Send this template with cryptographic proof
Every signed document gets PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-proof evidence package sealed in WORM storage.