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Other Names: Background and Reference Check Authorization
Consent to Background and Reference Check document preview

What is a Consent to Background and Reference Check?

A prospective employee may interview well, but it's always a good idea to make sure you really know who they are before you make the hire. Having a job applicant sign a Consent to Background and Reference Check gives you permission to check up on their application information and background. 
When your prospective employee signs a Consent to Background and Reference Check, you'll have their permission to confirm the information they provided on their job application and check their references. The Consent clearly explains what you plan to check and how you'll gather that information. A signed Consent to Background and Reference Check protects you and your company if an applicant later claims you unfairly invaded their privacy. If you choose, you can also get permission to run a criminal background check. Not all types of employment need to run a criminal background checks, but if it's relevant to the job (e.g. a security guard), you'll have the option to include it in your Consent to Background and Reference Check.

When to use a Consent to Background and Reference Check:

  • You're an employer who wants permission to run a background check on information a prospective employee provided.
  • You'd like to check to see if an applicant has a criminal record.
  • You're going to speak about an applicant's past job performance with their former employers.
  • You want to protect your company against future claims of invasion of privacy from employees or prospective employees.

Sample Consent to Background and Reference Check

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Consent to Background and Reference Check


Applicant Name:

Present Address: , ,

Social Security Number:


I, hereby authorize (the "Company") of , , , and/or its agents to make investigation of my background, references, character, past employment, consumer reports, education, and criminal history record information which may be in any state or local files, including those maintained by both public and private organizations, and all public records, for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for employment. A telephone facsimile (fax) or xerographic copy of this consent shall be considered as valid as the original consent.


I hereby consent to the Company's verification of all the information I have provided on my application form. I also agree to execute as a condition of employment or a condition of continued employment any additional written authorization necessary for the Company to obtain access to and copies of records pertaining to this information. I also hereby authorize the Company's access to any medical histories or records pertaining to me (and any other individuals who due to my employment may be covered by any Company medical or other insurance program). With regard to the foregoing disclosures, I hereby agree to release any person, company, or other entity from any and all causes of action that otherwise might arise from supplying the Company with information it may request pursuant to this release. I understand that any false answers or statements, or misrepresentations by omission, made by me on this application or any related document, will be sufficient for rejection of my application or for my immediate discharge should such falsifications or misrepresentations be discovered after I am employed.





By: Date:



Consent to Background and Reference Check document preview

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