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CANDIDATE BACKGROUND CHECK
Background Check / Disclosure Notification
A Consumer Report may include information
about your character, general reputation,
personal characteristics, or mode of living.
Upon written request made within a reasonable
period of time to the Consumer Reporting
Agency a complete and accurate disclosure
of additional information as to the nature
and scope of the Consumer Report will
be provided to you. You are entitled to
ask your prospective employer for a copy
of your Consumer Rights under the Fair
Credit Reporting Act (Revised 10/97) Release
of Information Form.
I understand that a Consumer Report or
an Investigative Consumer Report as described
above may be obtained. All corporations,
companies, credit agencies, financial
institutions, educational institutions,
persons, law enforcement agencies, courts,
former employers and military services
are authorized to release all written
and verbal information about me. I hereby
release all individuals, companies, corporations,
and agencies, public or private, connected
therewith from any and all liability associated
with the dissemination of such information
pertaining to me. I understand that I
may request a complete and accurate disclosure
of the nature and scope of the background
verification, to the extent that such
investigation includes information bearing
on my character, general reputation, personal
characteristics or mode of living.
Fill out the following information
(bold fields are mandatory) and click
'Submit'.
This is a background check for employment in:
Management Search
Healthcare Services
Finance & Accounting / Mortgage Banking |
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Applicant's
First Name:
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Last
Name:
Maiden Name:
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Social Security Number:
If you do not want to give this out over the Internet, call your Mission Search recruiter to provide it verbally. |
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| Date of Birth: MM / DD /19YY |
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Current Address:
City:
State, Zip:
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Email:
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School Attended:
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School City & State:
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Major:
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Last Year Attended:
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| Previous
Addresses:
(for past 7 years) |
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MOST RECENT
- City, State, Zip
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City, State, Zip
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City, State, Zip
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City, State, Zip
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City, State, Zip
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Authorization:
By checking this box and typing
my name below I hereby authorize
Mission Search to procure a consumer
report make any inquiry into my prior
employment (including contacting prior
employers), education as well as other
public record information. I understand
that inquiries may include any incidents
of dishonesty, violence or drug related
offenses.
Signed:
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Name of Mission Search recruiter
who's helping you:
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