8-Attachment C - Background Check.doc
DOC document 301 KB Posted
- Attached to
- Feral Hog Control & Abatement Services
- Solicitation number
- BTZ25-00028917
- Issued by
- Dallas County, Texas
About this file
This document is a Background Verification Release Form for an unspecified agency, designed to authorize comprehensive background checks on potential employees or volunteers. The form permits the investigation of an individual's criminal history, social security number, driving record, employment history, military background, civil listings, educational background, and professional licenses from various entities.
The form allows the screening organization (veriFYI) to conduct thorough background investigations, with the understanding that the information will be used to determine employment or volunteer eligibility. The applicant acknowledges that criminal history checks may be repeated throughout their employment or volunteer tenure, and they have the right to request additional information about the investigation. The document requires the applicant's signature, and if the applicant is under 18 years old, a parent or guardian's signature is also required.
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Text version
Background Verification Release Form
AGENCY INFORMATION
Date
Agency Name
Contact Name
| Agency’s Main Phone Number |
| Agency’s Fax Number |
Email________________________________________________________
APPLICANT INFORMATION:
Applicant Full Name (Last, First, MI)
Current Address
City State Zip Code
County
Social Security Number
Date of Birth
Driver’s License Number
State Issued
| Gender |
| ( Male ( Female |
| Race ( African American ( American Indian ( Anglo ( Asian ( Hispanic ( Other |
I hereby authorize veriFYI and or its Service Provider to request and receive any and all background information about or concerning me, including but not limited to my Criminal History, Social Security Number Trace including a consumer report under the Fair Credit Reporting Act, 15 U.S.C 1681, Driving Record, Employment History, Military Background, Civil Listings, Educational Background, Professional License from any Individual, Corporation, Partnership, Law Enforcement Agency, and other entities including my Present and Past Employers.
The criminal history, as received from the reporting agencies, may include arrest and conviction data as well as plea bargains and deferred adjudications and delinquent conduct as committed as a juvenile. I understand that this information will be used, in part, to determine my eligibility for an employment/volunteer position with this organization. I also understand that as long as I remain an employee or volunteer here, the criminal history check may be repeated at any time. I understand that I will have an opportunity to review the criminal history as received by client/agency and a procedure is available for clarification, if I dispute the record as received. I also understand that the criminal history could contain information presumed to be expunged.
I further release and discharge veriFYI and their Service Provider and all of their Subsidiaries, Affiliates, Officers, Employees, Contract Personnel, or Associates, from any and all claims and liability arising out of any request for information or records pursuant to this authorization, procurement of an investigative consumer report and understand that it may contain information about my character, general reputation, personal characteristics, and mode of living, whichever are applicable.
I understand that I have the right to make written request within a reasonable period of time to VeriFYI for additional information concerning the nature and scope of the investigation. I acknowledge that I have voluntarily provided the above information for employment/volunteer purposes, and I have carefully read and understand this authorization.
Applicant’s Signature
Date
Applicant’s Printed Name
Parent/Guardian’s Signature
(if under 18 years of age)
File details come from the government source that posted it. Updated .