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Background Check Form

 

 

REQUEST, AUTHORIZATION, CONSENT AND RELEASE FOR BACKGROUND INFORMATION 

 
PLEASE TYPE OR PRINT
I, understand that in conjunction with my application for employment,
Last Name First Name Middle Name (include Jr., Sr., II, III, etc.)
will use the service of an outside agency

agency to research and verify the information I have provided on my application for employment, including my personal background, character, professional standing, work history and qualifications. Said agency
uses llcasesinvestigativeservices.com as an agent to perform background verifications.

 

 

Allcasesinvestigativeservices.com will utilize various sources of information it deems appropriate, including, but not limited to, Department of Motor Vehicles records, credit reporting agencies, criminal conviction records, current and former employers, military records, school records, professional and personal references. I request, authorize and consent to the release and disclosure of any and all information, including, but
will provide a report to .
not limited to, the above to and allcasesinvestigativeservices.com. I unconditionally release and hold harmless
and allcasesinvestigativeservices.com.
Allcasesinvestigativeservices.com affiliates, and any named or unnamed corporation, company, custodian or records, or informant from any and all liability resulting from furnishing information about me.

 

 

 

I request, authorize and consent to the procurement of an Investigative Consumer Report, and understand that it may contain information about my background, mode of living, character and personal reputation.
This authorization, in original or copy form, shall be valid for one year from the date indicated next to my signature. According to the Fair Credit Reporting Act, I will be notified by if
employment is denied because of information obtained from said Information Provider. Upon written request within 60 days, I will be given a full and accurate disclosure as to the nature and substance of all
information provided to . I further understand that when requesting a copy of the report, proper identification will be required, and I should direct my request to:
Signed
Dated

All cases investigative services, 324 S. Diamond Bar Blvd # 203, Diamond Bar, CA 91765
 

 

 
Printed Name
Position Applied For
Social Security No.
Date of Birth
Driver's License No.
State
Other names you have used or are known as
 
PLEASE PROVIDE ALL RESIDENTIAL ADDRESSES FOR THE PAST 7 YEARS

 
Current:
Street
Apt#
City
State
ZIP
How Long Here?
Former:
Street
Apt#
City
State
Zip
How Long Here?
Former:
Street
Apt#
City
State
Zip
How Long Here?

 

 

                                                       From:

 

 
Company Name: Contact Name:
Telephone:
Fax:

 

Please fax this form to FAX: 909 865 2200 Telephone: 909-469-0427

 

 

 

 

 

                                           RELEASE FORM FOR CONSUMER REPORTS

 
From:
Telephone:
Fax:
 
 

In connection with my application for employment (including contract for services), I understand that consumer reports or investigative reports which may contain public record information, may be requested or made on me, including consumer credit, criminal records, driving record, education, prior employer verification, workers’ compensation claims, and others. These reports will include experience, along with reasons for termination of past employment. Further, I understand that you will be requesting information from various federal, state, local, and other agencies, which contain my past activities.

 

I hereby authorize, without reservation, any party or agency contracted by this employer to furnish the above mentioned information. I further authorize ongoing procurement of the above-mentioned reports at any time during my employment (or contract).

 
Print Name:
Maiden Name or AKA:
Address:
City:
State:
Zip:

 

Other counties you have lived in the past 10 years: 
Cunty:
State:
County
State:
 

For Identification Purposes Only:

Driver’s License No.:
State Issued:
Social Security No.:
Race:
Gender:
Date of Birth: Month
Day
Year
Professional License: State:
Type
Signature:
Date:

 

 

 

 

Please fax this form to FAX: 909 865 2200 Office Phone: 909-469-0427



Please Mail this from at help@allcasesinvestigativeservices.com

 

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