Background Check Authorization

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Employer / Requestor Information›Applicant Information›Authorization Scope…

Employer / Requestor Information4 questions

1. What is the employer's full legal name (as it will appear on the authorization form)?

2. What is the employer's mailing address and background-check contact information?

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3. What type of entity is the employer, and are any additional parties involved in the engagement?

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4. Who is the HR, recruiting, or compliance contact responsible for this authorization and the adverse action workflow?

Applicant Information9 questions

5. What is the applicant's full legal name (first, middle, last, suffix)?

6. Has the applicant used any prior names, maiden names, aliases, or professional credential names?optional

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7. What is the applicant's email address?

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8. What is the applicant's phone number for identity verification or CRA portal contact?optional

9. What is the applicant's current residential address (including county)?

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10. How will the applicant's date of birth, SSN, and driver's license number be collected for the background check?

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11. What position is the applicant being considered for, and what are its key duties and risk characteristics?

12. Which of the following duties or access rights apply to this position?

13. What is the applicant's relationship to the employer for this screening?

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Authorization Scope4 questions

14. Which types of background checks are being authorized for this position?

15. At what point in the hiring or employment process will the background check be ordered?

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16. Is this a one-time screening, or is the applicant authorizing ongoing/periodic rescreening during the employment or engagement?

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17. Who within the organization (or at third parties) may receive and review the background check report?

CRA / Vendor Information3 questions

18. What is the full legal name of the Consumer Reporting Agency (CRA) that will conduct the background check?

19. What are the CRA's address, phone number, website, and consumer dispute/privacy contact?

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20. Will more than one CRA, screening vendor, or sub-vendor be used for any component of this background check?

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FCRA Disclosures6 questions

21. Through what workflow will the applicant complete and sign the authorization?

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22. Which documents are being presented to the applicant as part of this authorization package?

23. How and when will the FCRA "Summary of Your Rights" be delivered to the applicant?

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24. Will the applicant be given an opportunity to request a free copy of the background check report?

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25. Will any part of this background check involve an Investigative Consumer Report (ICR) - meaning personal interviews about the applicant's character, reputation, or personal characteristics?

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26. What privacy notice(s) will be provided to the applicant regarding data collection, use, retention, and sharing?

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State-Specific Disclosures4 questions

27. In which state will the applicant primarily work?

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28. Does the applicant reside in a different state than where they will work?

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29. At what stage in the hiring process is this authorization being requested, and has a conditional offer been made?

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30. Which additional state or local notices or addenda will be included based on work location, check type, and hiring stage?

Adverse Action Process3 questions

31. Who will send pre-adverse and final adverse action notices, and what contact information should appear on those notices?

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32. What review window will you provide to the applicant after sending a pre-adverse action notice?

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33. What will be included in the pre-adverse action and final adverse action packets?

Applicant Signature9 questions

34. How will the applicant execute this authorization?

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35. When does this authorization expire?

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36. Can the applicant withdraw or revoke this authorization, and what are the employment consequences of doing so?

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37. Which of the following certifications should the applicant make in the authorization?

38. What date and location fields should appear on the signature block?

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39. Is the applicant under 18 years of age or otherwise requiring a parent or guardian to co-sign the authorization?

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40. Does the applicant require the authorization in a language other than English or in an accessible format?

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41. How long will signed authorizations, reports, adverse action notices, and related records be retained, and where?

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42. Any additional state or local disclosures, company-specific policy language, or custom provisions to include in the authorization?optional

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Required - please read and check this box to generate:ArtiEsq provides self-help legal information and document automation. ArtiEsq is not a law firm, does not provide legal advice, and use of this product does not create an attorney-client relationship. You are responsible for reviewing the document and determining whether you should consult a licensed attorney for legal advice about your specific situation.

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