Background Check Authorization Form Template
A free background check authorization form for employers and staffing agencies. Candidates read the disclosure, add their details and sign online.
Customize the pages and design to fit your needs.
About this template
Collect the details a screening company needs, with a plain disclosure of what will be checked and the candidate's rights. The candidate signs to authorize the check, and you keep a signed PDF with an audit trail. Check the wording with your counsel or screening company, since the FCRA asks for the disclosure to stand on its own.
Common uses
- Staffing agencies before each placement
- Employers after a conditional offer
- Volunteer and youth programs
Key features
- Disclosure and authorization to adapt
- Address history and other names
- Signed PDF with audit trail
What this template asks
What's your full legal name?
Short Text
Have you used any other names?
Short Text · Optional
What's your email address?
Email
What's your phone number?
Phone
What's your date of birth?
Date
What's your current address?
Short Text
Where else have you lived in the last 7 years?
Long Text · Optional
Which position are you applying for?
Short Text
Would you like a free copy of your report?
Yes / No
Background check disclosure and authorization
Agreement text, accepted with “I agree”
Sign the background check authorization
Signature
How to use this template
Copy it
Select Use template and a copy opens in your workspace as an unpublished draft.
Make it yours
Edit any question or answer, choose a theme, and add your logo.
Share it
Publish, then send the link, show a QR code, or embed the form on your site. Responses arrive in Submissions.
Background check disclosure and authorization
Signers read this text in the form before they accept it. Edit the bracketed details to match your business, and have the wording reviewed for your situation.
Please read this before you sign.
This authorization is between [Company name] (the "Company") and the applicant named in this form.
- Disclosure. The Company may get a background report about you for employment purposes, before you are hired and, where the law allows, during your employment.
- What may be checked. The report may include [criminal records, past employment, education, driving record and professional licenses].
- Screening company. The report will be prepared by [screening company name, address, phone and website].
- Your rights. You may ask the screening company for a copy of your report and a summary of your rights under the Fair Credit Reporting Act. If the Company may act on the report, you will get a copy first.
- Accuracy. You confirm that the details in this form are true and complete.
- How long this lasts. This authorization stays valid for [the hiring process or the length of your employment].
By signing below, I authorize the Company and its screening company to get the report described above.
Frequently asked questions
What goes on a background check authorization form?
The candidate's legal name, other names, date of birth, current and past addresses, the role, a plain disclosure of what will be checked, and their signature.
Who uses this form?
Staffing agencies, employers after a conditional offer, and volunteer or youth programs that screen people before they start.
Is this disclosure enough on its own?
It's a sample to start from, not legal advice. Your screening company may need more details, and some states require extra notices, so check with them first.