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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.


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.


  • CBSV – SSA-89 April 2023 Version
  • 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.