Fillable Bkgrd Check Authorization Short ALVIN COMMUNITY COLLEGE

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Bkgrd Check Authorization Short ALVIN COMMUNITY COLLEGE

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FORM: 09/19/14
ALVIN COMMUNITY COLLEGE
CONSENT TO PERFORM CRIMINAL HISTORY BACKGROUND CHECK
(IN COMPLIANCE WITH THE FAIR CREDIT REPORTING ACT – FCRA)
To provide a safer, more secure workplace, criminal history background checks are now an integral part of the
employment procedure. In an effort to avoid negligent hiring incidents, background checks are conducted on all
candidates recommended for employment at Alvin Community College. Background screening services are conducted
through JD Palatine LLC on a local and national level for this element of the employment procedure.
PLEASE PRINT / TYPE
DATE:
DEPARTMENT:
NAME:
(Last)
(First)
(M.I.)
OTHER NAMES
KNOWN BY:
(Maiden Name)
(Other Last Name)
(Other Last Name)
CURRENT
ADDRESS:
# YRS AT THIS
ADDRESS
(Street)
(City)*
(County)*
(State)*
(Zip)
PREVIOUS ADDRESS:
# YRS AT THIS
ADDRESS:
(Street)
(City)*
(County)*
(State)*
(Zip)
DRIVER’S LICENSE #:
LICENSE STATE:
PRIMARY PHONE#:
DATE OF BIRTH:
ETHNIC:
(MM/DD/YYYY)**
(Social Security Number)**
M
F
W
B
H
API
EMAIL ADDRESS:
I am an applicant for employment and/or current employee with ALVIN COMMUNITY COLLEGE, and have been advised that as a
part of the application / employment process, the Employer conducts a criminal history background check. By submission of this
form, I consent to the Employer, use of any information provided in the application process in performing the criminal history check.
The Employer has informed me that I have the right to review and challenge any negative information that would adversely impact a
decision to offer employment. In addition, I have been informed that I will have a reasonable opportunity to clear up any mistaken
information reported within a reasonable time frame established within the sole discretion of the Employer. Under the Fair Credit
Reporting Act (FCRA), I have been advised that upon request, I will be provided the name, address and telephone number of the
reporting agency, as well as the nature, substance and source of all information.
I authorize this background check for employment purposes; signature is not required.
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Bkgrd Check Authorization Short ALVIN COMMUNITY COLLEGE

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Completed 15 November 2019

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