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Compliance Forms for Background Screening
Authorization forms below are intended as a starting point of reference. Any use and/or modification of the forms below is up to the sole discretion of the user. BCS Background Screening, LLC does not assume any responsibility as to their compliant content. In addition, each individual state or municipality may have their own requirements and specific legal verbiage.
FCRA
- Sample Acknowledgment And Authorization For Background Check (written and/or electronic consent)
- Sample Disclosure regarding background checks
- Sample Background Check Authorization
- Sample Employment Background Check Release
- Notice Regarding Background Checks Per California Law
- Notice Regarding Credit Checks Per Vermont Law
- Notice Regarding Credit Checks Per City of New York Law
- Adverse Action Sample Letters
- Georgia GCIC/GBI Signed Release
- Nevada Department of Public Safety Background Check authorization
Driving Records Access – DPPA
Employers using DMVs for employment screening purposes must complete and sign both forms below:
- Affidavit of Intended Use – Required to enable DMV access
- Compliance Addendum – Required to enable DMV access
- Pennsylvania PennDOT end-user access form (Only for PA DMVs) – PennDOT mandates that, for an end user employer to receive access to real time MVRs, the end user employer must first complete the PennDOT form DL-9105 (5-22). This is a one-time requirement for each end-user employer.
SSA/IRS Forms
- CBSV (Consent Based SSN Verification)- SSA-89 April 2023 Version – Do not change or modify pre-filled text. Have applicant only sign and date. Must be wet signature.
- Employment History – IRS Form 4506-C
Disclaimer: BCS Background Screening, LLC is not responsible for the sole content of “sample only” forms provided above. While every effort has been made to maintain these forms updated, it is entirely your responsibility to consult legal counsel before using them.