REQUEST, AUTHORIZATION, CONSENT, AND RELEASE
FOR BACKGROUND INFORMATION
I have been informed and acknowledged that on April 13, 2016 the Alabama Community College System
Board of Trustees adopted Policy 623.01 requiring criminal background checks for all new and current
employees.
By signing this authorization, I hereby authorize the Alabama Community College System or its designee,
to conduct criminal reference searches for felony and misdemeanor convictions at the statewide and
national levels of every jurisdiction where I currently reside or where I have previously resided during the
past seven years; national sex offender registry searches and a search of my driving record.
I understand that I may voluntarily consent to the use of my social security account number for the
purpose of conducting a criminal background check. I further understand that my voluntary consent to
use my social security account number is being requested for purposes of conducting a criminal
background check, pursuant to the authority of the Alabama Community College System Board of
Trustees policy regarding criminal background checks. I understand that neither the Alabama Community
College System nor any employing authority within the Alabama Community College System will deny me
any right, benefit or privilege provided by law because of my refusal to voluntarily consent to the use of
my social security account number for the limited purpose of conducting a criminal background check
pursuant to the Alabama Community College System Board of Trustees policy regarding criminal
background checks.
______I voluntarily consent to the use of my social security account number for the limited
purpose of conducting a criminal background check. Social Security #_______________
______I do not consent to the use of my social security account number for the limited purpose of
conducting a criminal background check.
______I consent to the use of my driver’s license number to be used for the limited purpose of
conducting a review of my driving history.
_____ I do not consent to the use of my driver’s license number for the limited purpose of
conducting a review of my driving history.
The information I have given in my employment application, interviews, and/or related resumes and
documents is true, complete, and accurate.
I understand and agree that if employed, and/or during any period of employment, any false statements,
misrepresentations of facts, or omission made by myself become known, my employment shall be subject
to immediate termination.
I understand that in the event a conviction for a felony or any crime involving moral turpitude is found that
the procedures established for the Board of Trustees policy concerning criminal background checks will
be followed.
I have read and completely understand this release.
Applicant’s Signature: __________________________________ Date: __________________
Applicant’s Name (Please print): ___________________________________________________
Applicant’s Address: ____________________________________________________________
Applicant’s Birthday: ____________________________________________________________
Applicant’s Driver’s License Number: _______________________________________________
Applicant’s Driver’s License State: _________________________________________________
Revised March 2019
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