Applicant Release Form
BACKGROUND CHECK APPLICANT RELEASE FORM
All Background and People Checks
211 Southeast 12th Street
Topeka, Kansas 66612-1106
http://people-checks.com * info@people-checks.com
Bus: 785-274-9883
Fax: 877-777-5121
Cell: 785-383-6250
All Questions must be completed in their entirety
PLEASE PRINT LEGIBLY SO WE CAN PROCESS YOUR REPORT WITHOUT DELAY.
Print First - Middle - Last Name (complete middle name, no initial) ______________________________________________________________
Current Address:__________________________________________________________
City:________________ County:_____________ State:___________ Zip Code:_______
SS#:_______________ Date of Birth: ___/___/___ D.L.#:__________or State ID #__________
State Issued_____________
Former Address:________________________ City:__________ State:___ Zip:________
(please list all former address from every state you have lived in – use the back if necessary)
I hereby authorize All Background & People Checks, or subsidiaries or related companies through their agent to request and receive any and all background information about or concerning me, including but limited to my Criminal History, Driving Record, Employment History, Military Background, Civil Listings, Educational Background, Professional License from any Individual, Corporation, Law Enforcement Agency, other entities including my Present and Past Employers, and if applicable to the position, a Credit History including a consumer report under the Fair Credit Reporting Act, 15 U.S.C. 1681.
I also understand authorize the release all information regarding my services, character, conduct, accidents and safety performance. This also authorizes the release of all drug and alcohol testing and results while in other employ in accordance with Federal Motor Carrier Safety Regulations part 382.413. Former employers are released and held harmless of any liability from release of said information.
I further release and discharge All Background & People Checks and their agent, and all their Subsidiaries, Related Corporations, Affiliates, Officers, Employees, Contract Personnel, or Associates, from any and all claims and liability arising out of any request for information or records pursuant to this authorization, procurement of an investigative consumer report and understand that it may contain information about my character, general reputation, personal characteristics, and mode of living, whichever is applicable.
I acknowledge that I have voluntarily provided the above information for employment purposes, and I have carefully read and understand this authorization.
Signed:______________________________________________Date________________
Click on the checkmark image to download and print the Form
Click on the Red Checkmark to Download and Print the Release Form
(prints out on 1 page) After completion, Fax or E-Mail the Form to us so we
can start processing your Report immediately.