As part of its employment screening and selection procedures, Liberty University (hereafter referred to as “Company”) requires that a
background investigation and a check of references be conducted. The objectives of the investigation are to verify information
provided during the application process, investigate references and identify any factors that might be inconsistent with Company
employment requirements.
I, ______________________________________, give Company permission and authority to conduct a background investigation and
(applicant’s name)
reference check into my past and current activities. I understand and consent to an investigation that may include, but is not limited
to, information as to my personal character, general reputation, verification of previous employment and employment references,
verification of education, credit history, motor vehicle driving record, social security wage information, criminal records, sex offender
registries and other information contained in public records.
I authorize and request any Former Employers, Schools, Police Departments, States, Cities and Counties, or any other Person to
furnish Company all of the following requested concerning:
My Work Habits Character Criminal Record Reasons for Termination
Reputation Driver Record Salary History Workers’ Comp Claims
Education History Credit History
And all other relevant information requested by Company.
By checking this box, I am indicating my present employer should NOT be contacted.
I hereby release all Persons, Companies, Corporations, Schools, or individual from all liability and responsibility that may result from
providing Company with such information as requested.
I understand that if hired, my employment is for no definite period of time, consistent with state law, and may be terminated with or
without cause and with or without notice, at any time, at the option of either Company or myself. No employee, representative,
manager, official or supervisor of Company other than the Human Resource Office has any authority to enter into any agreement for
employment for a specified period of time or make any agreement relative to employment that is contrary to the foregoing. Any such
employment agreement will be in writing, signed by the designated officer and clearly specifying its term.
I understand that I have the right to request the complete and accurate disclosure of the nature and scope of any investigative
consumer report performed, and hereby acknowledge receipt of the Federal Trade Commission’s summary of consumer rights
enclosed herein.
First, Middle, Maiden, Last Name
Social Security Number
Current Street Address (No P.O. Box please)
City, State, Zip Code
Driver’s License Number and Issuing State
Date of Birth
PLEASE NOTE: The Age Discrimination in Employment Act of 1967 prohibits discrimination on
the basis of age with respect to individuals who are at least 40 years of age.