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Content
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