Background Review Authorization

To be considered for this position we require the completion of this background review authorization form below along with our company application.

A member of our HR department will review application materials and contact you if we are interested in continuing on to the next steps in the employment process.

Information for Employment Background Review

Name: *

First

Middle

Last

Maiden Name:

First

Middle

Last

Date of Birth: *

MM/DD/YYYY

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Current Address (if different):

Driver's License # and State Issued:

Name on Driver's License:

Phone Number: *

Email: *

Prior Residence: (Past 5 Years) Address, Dates Lived In *

Electronic Signature Name: *

First

Last

Electronic Signature Date: *

MM/DD/YYYY

Name

I hereby authorize LDF Business Development Corp. and its designated agents and representatives to conduct a comprehensive review of my background through an investigative report to be generated for employment, promotion, reassignment or retention as an employee. I understand that the scope of the investigative report may include, but is not limited to, the following areas: verification of Social Security Number; current and previous residences; employment history, including all personnel files; education; references; criminal history, including records from any criminal justice agency in any or all federal, state, county or tribal jurisdictions; birth records; motor vehicle records, including traffic citations and registration; and any other public records.

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 understand that I must provide my date of birth to adequately complete said screening and acknowledge that my date of birth will not affect any hiring decision. I hereby authorize and request any present or former employer, school, police department, financial institution, or other persons having personal knowledge of me to furnish LDF Business Development Corp or its designated agents with any and all information in their possession regarding me in connection with an application for employment. I am authorizing that a photocopy of this authorization be acceptable with the same authority as the original.

I hereby release LDF Business Development Corp. 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 and request to release. This release shall remain in effect for one (1) year from the date electronically signed or upon termination of employment, whichever is sooner. All information received from this authorization shall be maintained in a confidential manner in order to protect the applicants’ personal information.