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Human Resources Forms

FORM:

Background Check Authorization

ABOUT:

Certain positions require a successful background check as condition
of employment.

AUDIENCE:

UC
Davis

SEND TO:

Hiring Manager

Last updated: Dec. 2017

DO NOT MODIFY THIS FORM
UNIVERSITY OF CALIFORNIA, DAVIS
EMPLOYMENT PROGRAM

3a

3b

ACTION TYPE:

1

APPLICANT’S NAME: (LAST, FIRST, MIDDLE INITIAL)

VOLUNTEER*

NEW HIRE

START DATE:

PROMOTION

END DATE:

DEMOTION

PSS \STAFF*

TRANSFER

CAREER HIRE/PROMOTION/TRANSFER:

MSP*

RE-CLASS

DO NOT LIST STUDENT HIRE HERE

ACADEMIC*

PD UPDATE

SR. MGMT.*

CONTRACT

STUDENT **

CONTROLLED SUBSTANCE

CURRENT EMPLOYEE: Y / N

CIRCLE LOCATION:

EMPLOYEE ID :

UCD CAMPUS

2a
UCD MED

CTR RECRUITER’S NAME
E-MAIL ADDRESS

STUDENT TITLE CODES:

4919, 4920, 4921, 4329, 4923, 4924,
4925(UNDERGRADUATE STUDENTS)

NOTE: YOU MAY WISH TO
CONTACT HR TO CONFIRM IF

* REQUIRES BOTH DOJ & FBI CHECKS

APPLICANT HAS EXISTING CHECK

** UNDERGRADUATE STUDENT
EMPLOYEES REQUIRE ONLY A DOJ
C