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:
______________________________