Free Background Check Form

Background Check Form:

All information will be kept strictly confidential.
 
Name _________________________________________________________
                      First                                     Middle                     Last
 
Address  _______________________________________________________
                      Street                                    City                State                         Zip
 
Maiden Name or Other Names Used _________________________________
 
Date of Birth _____________________
 
Social Security #  __________________________
 
Have you ever been arrested or convicted for any criminal offense excluding
minor traffic violations?  ____________
. 
Have you ever been accused, arrested or convicted of abuse or sexually related crimes?  _________________
 
Is there anything in your life-style or background that would call into question your ability?  _______________

If  you answered yes to any of these questions, please explain:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please note:  answering "yes" to any of these questions does not automatically disqualify you.  Please use the spaces  provided to explain the circumstances. 

I hereby authorize _______________ to make an independent investigation of my background and criminal or police records.  I release _______________, and any person or entity which provides information pursuant to this authorization, from any and all liabilities, claims or law suits in regards to the information obtained from any and all of the above sources.  The information contained in this application is correct to the best of my knowledge.  I  understand that any omission of material fact on this application may be grounds for rejection of this application.

Signature _________________________________________________   Date ________________
 

Please write any questions or comments you have on the back of this sheet.