Veritas Investigations 
Applicant Notice & Consent For
Background Investigation

Fax This Form and Copy of Job Application To (937) 434-6060

I , ___________________________ (Applicant Name) hereby authorize Veritas Investigations and its designated agents and representatives to conduct a comprehensive review of my background for the purpose of generating a Background Investigation Report (also known as a “consumer report” or an “investigative consumer report” as defined in the Fair Credit Reporting Act).  The report will be provided to  ______________________________   (Employer Name) for use in considering my application for employment, promotion, reassignment or retention by that Company 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, citizenship, current and previous residences; employment history including all personnel files and records of disciplinary action; education to include transcripts and records of attendance/graduation; character references; credit history and reports; criminal history records from any criminal justice agency in any or all federal, state, or county jurisdictions; birth records; motor vehicle records, to include traffic citations and registration; and any and all public records.

I, ___________________________ (Applicant Name) hereby authorize individuals, companies, firms, corporations, and public agencies to release any records pertaining to me to Veritas Investigations, or their agents, for the purposes of this Background Investigation, and have agreed to provide my date of birth, and social security number, and other employment and residential history information for use in identifying records and data that may pertain to me.  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 bearer with any and all information in their possession regarding me in connection with my application for employment, promotion, or retention. This authorization and consent shall be valid in original, fax, or copy form.

I hereby release Veritas Investigations, the employer and their agents, officials, representatives, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may at any time, result to me, my heirs, family or associates because of compliance with this authorization and request to relapse. I understand that a copy of this authorization may be given to me at any time, provided I request it in writing. Information in this authorization and the results of the background investigation will be maintained in confidence in accordance with the employer’s hiring practices.

Printed Name of Applicant/Employee:  ________________________________________________________

Signature of Applicant/Employee:    __________________________________________________________

Applicant/Employee Date of Birth:   ___________________   Social Security Number __________________

Applicant's Current Address: ________________________________________________________________

Date of Signature:     ______________________________


Please Fax This Form & A Copy of The Applicant/Employee's Job Application To (937) 434-6060