Professional Documents
Culture Documents
Background Check Form
Background Check Form
Failure to provide
complete and truthful information may result in the refusal or delay of your application. Please print clearly.
PERSONAL INFORMATION
Last Name: Civil Status:
Current Address:
Permanent Address:
Name of Institute:
Address / Location:
Dates of Attendance:
(MM/DD/YYYY) to (MM/DD/YYYY)
Graduate? Yes No | If yes, specify date below: Graduate? Yes No | If yes, specify date below:
Date of Graduation:
Course / Qualification:
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I hereby grant authorisation the employer and any person or organisation acting on its behalf to verify information presented in my
application form and to procure a background screening report for that purpose. I understand that such a report may contain
information about my background, character and personal reputation. I further understand and agree that, in the event of my
employment, a background screening report may be procured in connection with subsequent employment decisions.
Upon my written request, I will be advised of the name and address of each employment reporting agency from which an
employment report or investigative report may have been obtained. I also voluntarily authorise ______________, and a vendor on its
behalf, to perform reference checks of my employment (with the exception of my current employer, unless I have authorised such
contact or commenced employment with Employer) and such other checks and inquiries are necessary in order to verify information
provided by me in my employment application. I hereby release from liability all persons or entities requesting or supplying such
information. Moreover, I understand that my employment with the Firm may be terminated with immediate effect should any
information provided herein be proven untrue.
Identity #: _____________________________
(valid ID)
Date: _____________________________
Signature: _____________________________
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