Free background check form 41
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BACKGROUND CHECK AUTHORIZATION AND RELEASE FORM
Last Name

First Name

Middle Name

Soc. Sec. #

Driver Lic # (MVR Only)

Date of Birth

Maiden and all other names used

Present Address

City

Length at present address

(If less than 7 years please provide previous addresses)

Prior Address

City

State

Zip

County

Prior Address

City

State

Zip

County

State Issue

State

Zip

County

I hereby authorize the release to Blueline Services, an independent background screening agency, any information regarding my prior
employment, criminal, credit, driving, workers compensation, and educational history; as well as, information
regarding my general character and reputation. I understand the information may be reviewed initially and periodically during the course of
my employment for future screening for retention, promotion, or reassignment.
I understand that my background may be used to determine my eligibility for employment, and I agree that falsification may make me
ineligible for e