Demo Company Electronic Consent Form

Employee Candidate Authorization
Federal Disclosure of Intent to Obtain Consumer Reports or Investigative Consumer Reports

"Consumer reports" are reports from consumer reporting agencies and may include driving records, criminal records, etc.

For such employment purposes, the Company may also obtain investigative consumer reports. Some reference checks by a consumer reporting agency fall into this category. An "investigative consumer report" is a consumer report in which information as to character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with neighbors, friends, associates, acquaintances, or others.
You have a right to request: (i) disclosure of the nature and scope of the investigation requested, (ii) a written summary of consumer rights, and (iii) a copy of such report.

AUTHORIZATION
I authorize the Company to obtain and release consumer reports and/or investigative consumer reports,
including criminal reports, regarding me from time-to-time for employment purposes.

All fields are required. If a section does not apply, please type none or n/a.
Today's Date*
MM slash DD slash YYYY
Company Identification
Company Name*
Select the business location that is considering you for employment.
Candidate Identification
Name*
First Middle Last Suffix
Maiden name
List any other names (name change, assumed name, nickname, etc.) which you may have used, and which will be necessary to verify prior to your employment:
Email*
Cell Phone*
Personal Identification
Date of Birth*
MM slash DD slash YYYY
Social Security Number*
Confirm Social Security Number*
Driver's License Number*
Driver's License State*
Other Driver's License held in past 5 years*
Gender*
Race*
PROVIDE YOUR FULL RESIDENTIAL ADDRESS HISTORY FOR THE LAST 7 YEARS
(CANNOT BE A PO BOX)
Current Address
Street*
City*
State*
Zip Code*
How long have you lived at this address?*
- Less than 7 years
- More than 7 years
Previous Addresses
Previous Address #1*
Street Address Address Line 2 City State ZIP Code
How long did you live at previous address #1?*
Previous Address #2
Street Address Address Line 2 City State ZIP Code
How long did you live at previous address #2?
Previous Address #3
Street Address Address Line 2 City State ZIP Code
How long did you live at previous address #3?
Identity Verification
Upload Driver's License*
Accepted file types: jpg, gif, png, pdf, Max. file size: 128 MB.
Upload Social Security Card
Accepted file types: jpg, gif, png, pdf, Max. file size: 128 MB.
Name
This field is for validation purposes and should be left unchanged.

Please call SecureHire at 678-527-1909 if you have any problems related to this consent form.

Employee Candidate Authorization

Company Identification

Candidate Identification

Personal Identification

Current Address

Previous Addresses

Identity Verification