Discover the contents and sample of an employee background check consent form.

Sample employee background check consent form

If an employer feels the need to perform a background check on their new employees, they are required to seek authorization from the employee. In return, the employee fills a consent form agreeing to the exercise. They write a consent allowing the employer to perform the check using law enforcement agencies and any other private investigators. What are the key components of the employee background check consent form?

Contents of the consent form

Notification - In this section, the employee’s notifies whomever that will receive the authorization form, they agree to the background check due to their position in the employer’s organization. They outline the scope of the check.

Authorization - Here the employee authorizes the company to perform the background check within the scope provided in the notification section. They allow any enforcement agencies and investigators to assist the company in conducting the check.

Employee details - In this section, the position applied for, and the department is listed. The legal name of the employee is also included. Any other names, which the individual might have been used within the past 7 years, should also be reflected here. They also need to fill in their current, previous and other addresses they might have lived in within the past 7 years. Other details include a phone number, alternate contact, date of birth, security number, gender, and driver’s license details. Lastly, the employee should indicate if they have been accused of crimes before and the charges.

Declaration by the employee - In the conclusion, the employee should declare that the information offered is true and they authorize the company to carry out a background check.

Sample of employee background check consent form


The position that I applied requires me to agree to a criminal background check as a requirement of employment. This background check includes undertaking a search in the criminal history for felony and convictions in the state and federal levels in any jurisdiction where I live currently or where I have lived within the past 7 years.


I, therefore, authorize MTFS to perform the criminal background check as outlined above. In relation to this, I also authorize the company to use law enforcement agencies and private investigators to gather this information.

I am aware that information on arrests or pending convictions is not a barrier to employment. The information will be utilized in establishing whether the results of the check reflect my trustworthiness or my capabilities to perform the responsibilities of my position in a way that is safe for the employees of MTFS.

Position Applied for: […]

MTFS Department: […]

Full Legal Name: […]


Other Names Used in Past 7 Years: […]

Current Address: […]

Previous Address (most recent): […]

Addresses in the 7 years before completing this authorization: […]

Phone Number: […] Other Phone Number: […]

Date of Birth: […] Gender: Female/Male

Social Security Number: […]

Driver License No: […]            Driver’s License State: […]

Do you have criminal offense conviction record or have pending charges?

Note: This refers only to felonies and misdemeanors; you do not need to include non-criminal traffic violations or municipal ordinance violations.


To the best of my knowledge, the information that I provided in this notice and authorization including attachments is complete and true. It is my understanding that omitting or falsifying information may lead to my disqualification from this position. By signing here below, I authorize MTFS to conduct the criminal background check, and I confirm that I was informed about my rights through the Fair Credit Reporting Act. Additionally, I understand that I can appeal the decision that MTFS will make based on the results of the criminal background check within 3 days after receiving the notice and the decision about my appeal will be made within 7 days after MTFS receives such as an appeal.

Signature: […]

These articles may interest you