Get a free sample of the employee background check form authorization including contents therein.

Employee background check form authorization free sample

To ensure that you hire the right and credible individuals to run your organization, you should strive to know them better. You can have your new employees sign an agreement to check their background, what is referred to as the employee background check form authorization. It is used by an employer to seek permission to conduct a check on the information that the employee gave during the interview or the recruitment process. It also becomes handy when the employer wants to find out if the employee has a past criminal record. In addition, the authorization helps in a situation where the employer would like to talk to references on the employee’s job performance.

What constitutes an employee background check authorization form?

Need for the check

In this section, the employer informs the employee that a criminal background check is crucial for employment. They also outline the scope of the process. For instance, they can state that the check will entail checking public records to look for a record of criminal convictions. It is vital for the employer to provide a legal backing to the process, based on the federal and state laws. Lastly, they should assure the employee that their record will not make them lose the position unless in situations where it is required by law.

Employee details

Here is where the employee will fill in their details including name, social security number, names used in the last 10 years or less.

History of residence

Here the employee fills in the details about their addresses over the last 10 years.

Declaration of the company to conduct the background check

In this section, the employer should express their right to conduct a criminal background check on the employee. They should state that the information gathered would not be used in the future to discriminate the employee based on gender, race, color, religion, sexual orientation and military status among others.

Declaration by the employee to abide by the check

Here the employee is informed that by signing the authorization form, they agree to allow the company to perform a background check on them. They also express their accountability, if they provide misleading or falsified information.


Criminal Background Check Authorization Form

A criminal background check is a requirement for employment. The check entails looking into public records establishing the existence or non-existence of record of criminal charges or convictions. Federal and state law indicates that certain individuals who have been convicted of a crime are not appropriate candidates for particular positions. However, prior criminal convictions do not automatically exclude one from employment.

Full Name: […]

List other names and date of change during the last 10 years

Full Name: […] Date: […]

Full Name: […] Date: […]

Date of Birth: (MM/DD/YYYY)

Social Security Number: […]


Has this social security number been issued in the last 90 days?       Yes__   No _


Residence history: Give complete addresses in the last 10 years






State/Zip Code


Date From





























Carolina Agency maintains the right to perform, through state agencies or a third part, a background check on criminal record of any job applicant or employee. The information found through the check will not be used in discriminating any employee or applicant based on religion, color, gender, sexual orientation, national origin, age or military status.

By signing this form, you authorize the Carolina Agency and/or its hired third party to perform a criminal background check. Additionally, you confirm that any misleading information, falsified information or failure to disclose any information, may lead to disqualification or dismissal from employment.

Applicant/Employee Signature: […] Date: […]

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