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Authorization Form

The document authorizes ProQuest Consultancy Services to conduct a background check for employment purposes. It allows the release of records including employment history, criminal records, driving records and more. The applicant confirms the information provided is accurate and understands false statements could result in termination.

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82 views1 page

Authorization Form

The document authorizes ProQuest Consultancy Services to conduct a background check for employment purposes. It allows the release of records including employment history, criminal records, driving records and more. The applicant confirms the information provided is accurate and understands false statements could result in termination.

Uploaded by

z31404758
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Authorization for Release of Information for Employment Purpose

Background Screening Disclosure

I hereby authorize ProQuest Consultancy Services Pvt Ltd, Hyderabad and its designated
agents and representatives to conduct a comprehensive review of my background through
a consumer report and/or an investigative consumer report to be generated for
employment, promotion, reassignment, or retention as an employee. I understand that
the scope of the consumer report/investigative consumer report may include, but is not
limited to, the following areas: names and dates of previous/current employment, work
experience, worker’s compensation claims, criminal history records (from local, state,
federal, international and other law enforcement agencies’ records), sexual offender’s
lists, wants and warrants records, motor vehicle records, military records, educational
verification, license verification, credit history, civil cases, OIG/GSA, OFAC/patriots act,
any sanction lists, FBI finger printing and drug testing.

Authorization and Release

I, _ _, authorize the complete release of these records or data pertaining to me which an


individual, company, firm, corporation, or public agency may have. I authorize the full
release of the information described above, without any reservation, throughout any
duration of my employment at Nisum Technologies. I hereby release PROQUEST, and its
agents, officials, representatives, or assigned agencies, including officers, employees, or
related personnel both individually and collectively, from any and all liability for damages
of whatever kind, which may at any time, result to me, my heirs, family or associates
because of compliance with this authorization for release of information. I certify that all
information provided below and on my resume is correct to the best of my knowledge.
Any false statements provided in this form and my resume will be considered just cause
for the termination of employment at any time. This authorization and consent shall be
valid in original, fax, or copy form.

The following information is required by law enforcement agencies and other entities for
identification purposes when checking records. It is confidential and will not be used for
any other purpose.

Applicant’s Name (First) Middle Name Surname

_________________________ ___21__/__07____/2022_____
Signature Date

_____/____/______
Date of Birth (This will not affect hiring decision)

_____________________________ ___
Driver License Number State

Current Address

Phone

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