Please reserve 20-30 minutes of time to fill out the background check authorization form below. The results of your background check will be sent to the employer requesting it. Upon request you can receive a copy of the background check – please contact us to request a copy.

Background Check Authorization Form

Section 1: Applicant Information

Name
Name
First
Middle
Last
Other names or aliases you have used (ie. maiden name)
Other names or aliases you have used (ie. maiden name)
First
Middle
Last
if none write "N/A"
Current Physical Address
Current Physical Address
Address Line 1
Address Line 2
City
State/Province
Zip/Postal
Country
Different Mailing Address?
Mailing Address
Mailing Address
Address Line 1
Address Line 2
City
State/Province
Zip/Postal
Country
Have you lived anywhere else within in the last 7 years?
Previous Address 1
Previous Address 1
Address Line 1
Address Line 2
City
State/Province
Zip/Postal
Country
Another previous address to add?
Previous Address 2
Previous Address 2
Address Line 1
Address Line 2
City
State/Province
Zip/Postal
Country
Another previous address to add?
Previous Address 3
Previous Address 3
Address Line 1
Address Line 2
City
State/Province
Zip/Postal
Country