# 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.

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.

Canonical: https://reuily.com/templates/background-check-authorization-form
Use this template: https://reuily.com/form/from-template/background-check-authorization-form
Collections: Agreements & Waivers, Staffing & Recruiting, Human Resources
Last updated: 2026-10-24

## Questions

- Question 1: What's your full legal name? (Short Text, required)
- Question 2: Have you used any other names? (Short Text, optional)
- Question 3: What's your email address? (Email, required)
- Question 4: What's your phone number? (Phone, required)
- Question 5: What's your date of birth? (Date, required)
- Question 6: What's your current address? (Short Text, required)
- Question 7: Where else have you lived in the last 7 years? (Long Text, optional)
- Question 8: Which position are you applying for? (Short Text, required)
- Question 9: Would you like a free copy of your report? (Yes / No, required)
- Agreement: Background check disclosure and authorization, accepted with "I agree" (full text below)
- Question 10: Sign the background check authorization (Signature, required)

Signing records the signer's consent, email, IP address, browser and signing time, and each signer can download a signed PDF copy.

## Background check disclosure and authorization

Please read this before you sign.

This authorization is between **[Company name]** (the "Company") and the applicant named in this form.

1. **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.
2. **What may be checked.** The report may include **[criminal records, past employment, education, driving record and professional licenses]**.
3. **Screening company.** The report will be prepared by **[screening company name, address, phone and website]**.
4. **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.
5. **Accuracy.** You confirm that the details in this form are true and complete.
6. **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.

## 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

## 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.