Free background check form 05
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Background Check Consent and Release Waiver
National Background Screening Consent Form
Applicant’s Legal Name (printed)
Social Security Number

Date of Birth

Applicant’s Address



, authorize and give consent for the above
named organization to obtain information regarding myself. This includes the following:

Local & National Criminal background records/information
All 50 State Sex Offender Registries
Full Address Trace
Social Security Verification

I, the undersigned, authorize this information to be obtained either in writing or via
telephone in connection with my application. Any person, firm or organization providing
information or records in accordance with this authorization is released from any and
all claims of liability for compliance. Such information will be held in confidence in
accordance with the organization’s guidelines.
By signing this document, I am providing the above named Organization my consent
for an initial background check as well a