Free background check form 10
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CONFIDENTIAL

Organization Name
Background Check Authorization
Print Name:
(First)

(Middle)

(Last)

Former Name(s) and Dates Used:
Current Address Since:
(Mo/Yr)

(Street)

(City)

(Zip/State)

(Mo/Yr)

(Street)

(City)

(Zip/State)

(Mo/Yr)

(Street)

(City)

(Zip/State)

Previous Address From:
Previous Address From:
Social Security
Number:

Date of
Birth:

Telephone Number:
Drivers License Number/State:

The information contained in this application is correct to the best of my knowledge. I hereby authorize
(Organization Name) and its designated agents and representatives to conduct a comprehensive
review of my background causing a consumer report and/or an investigative consumer report to be
generated for employment and/or volunteer purposes. I understand that the scope of the consumer
report/ investigative consumer report may include, but is not limited to the following areas: verification of
social security number; current and previous residences; employment history, education b