Background Check Authorization Form Template

Thank you for your interest in our company. To proceed with the application process, please complete and sign our Background Check Authorization Form. 
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Full Name*
First Name
First Name
Last Name
Last Name
Date of Birth*
Phone Number*
Current Address*
By submitting this form, I authorize the XXX company to conduct a background check and verify the information provided above. I understand that any false statements or omissions may result in disqualification for employment or termination if already employed.
Date Signed*
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