PRE-EMPLOYMENT BACKGROUND CHECK AUTHORIZATION
I,
understand that as part of the employment process, Angels Helpers, Inc. needs to complete a background check on me regarding:
o I authorize all federal and state agencies, persons and organizations that may have information relevant to this research to disclose such information to Angels Helpers, Inc. or its authorized agent(s).
o I understand that this authorization is to be part of the written and signed employment application.
o I also understand that I do not have to give authorization for a background check but if I don’t give permission, my employment application will not be processed further.
o I understand that I have specific rights under the federal Fair Credit Reporting Act (FCRA) and may have additional rights under relevant State law.
o I further authorize that a photocopy of this authorization may be considered as valid as the original.
o I hereby certify that all statements on this form are true and correct to the best of my knowledge and belief. I understand that employment with Angels Helpers, Inc. is contingent upon the successful completion of a background check.
Signature:
Full Name
Telephone No.
Former Name(s)
and Date(s) used
Current Address
Date of Birth
Social Security Number:
Current Driver’s License:
State:
List any other cities, states and dates of residency during last 10 years
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