Background Check Forms for Employers: FCRA, DPPA and SSA Samples
Download sample background check forms for every step of employment screening.
This page covers FCRA disclosure and authorization, state notices, adverse action letters, and driving record forms. Additionally, each form opens as a web page or a PDF.
Samples only: These forms are a starting point, not legal advice. Therefore, ask your legal counsel to review them before use.
FCRA Background Check Forms: Disclosure and Authorization
The Fair Credit Reporting Act (FCRA) sets two duties before you order a report.
First, tell the applicant in writing that you may use a background report for employment decisions.
Second, get the applicant’s written permission. According to the FTC guide for employers, the notice must be in a stand-alone format. Therefore, keep these background check forms out of your job application.
Acknowledgment and Authorization for Background Check
Sample background check authorization form. It supports written or electronic consent.
Disclosure Regarding Background Investigation
Sample background check disclosure form. It tells the applicant that you may order a report.
Background Check Authorization Form (PDF)
Fillable PDF of the same authorization. The applicant types a name, checks the boxes and signs.
Background Check Disclosure Form (PDF)
Fillable PDF of the same disclosure. First, type your company name. Then, give it to the applicant.
State and City Background Check Notices
Federal law is only the baseline. Moreover, several states and cities require their own notices or releases. Use the forms below when you hire in these places.
Notices for Applicants and Employees
Notice Regarding Background Checks Per California Law
Give this notice to California applicants and employees you screen.
Notice Regarding Credit Checks Per Vermont Law
Use this notice when you run a credit check on a Vermont applicant or employee.
Notice Regarding Credit Checks Per City of New York Law
Use this notice when you run a credit check for a New York City position.
State Agency Releases
Georgia GCIC/GBI Signed Release
Signed release for a Georgia criminal history search through GCIC and GBI.
Nevada Department of Public Safety Background Check Authorization
Authorization form for a Nevada Department of Public Safety background check.
State by State Employment Screening Laws
In addition, compare your process with the rules for each state and city.
Adverse Action Letters: Two Notices, in Order
Sometimes a report leads you to reject an applicant. In that case, the FCRA requires two notices. Send them in this order.
- 1
Pre-Adverse Action Notice
First, send the applicant a copy of the report you relied on.
Also include “A Summary of Your Rights Under the Fair Credit Reporting Act.”
- 2
Adverse Action Notice
Then, after the decision, name the screening company and give its address and phone number.
Additionally, state that the screening company did not make the decision.
Finally, explain the right to dispute the report and to get a free copy within 60 days.
Driving Record Forms: DPPA Access for Employers
The federal Driver’s Privacy Protection Act (DPPA) limits who may receive motor vehicle records (18 U.S.C. § 2721).
Consequently, employers who order driving records for employment screening must complete and sign both forms below.
Required for Every Employer
Affidavit of Intended Use
Required to enable DMV access. Therefore, complete it before your first order.
Required in Some Cases
PennDOT Form DL-9105 (5-22)
Only for Pennsylvania driving records.
PennDOT requires this form before an end-user employer receives real-time MVRs.
However, it is a one-time requirement for each end-user employer.
DOT Pre-Employment Screening Program (PSP) Form
FMCSA disclosure and authorization form for a driver’s PSP record.
Print BCS Background Screening LLC as “employer.”
In addition, the driver must date and sign it by hand. The program does not accept e-signatures.
SSA and IRS Consent Forms
Some verifications go straight to a federal agency. Therefore, the applicant must sign that agency’s own consent form.
Form SSA-89: Consent Based SSN Verification (CBSV)
May 2025 version. With the applicant’s consent, CBSV checks whether a name, date of birth and SSN match SSA records.
Do not change or modify the pre-filled text.
Instead, have the applicant only sign and date the form. It must be a wet signature.
IRS Form 4506-C: Employment History
This form lets the IRS release tax transcripts with the applicant’s signed consent.
For the current version, contact our support team.
How to Use These Background Check Forms
- 1
Match the Form to the Search
First, choose the forms your search requires.
For example, driving records need the DPPA forms.
- 2
Add State and City Notices
Next, check where the applicant lives and works.
Then, add any notice that place requires.
- 3
Ask Counsel to Review
These forms are samples only.
Therefore, have your legal counsel approve the final wording.
- 4
Collect Signatures and File Them
Finally, get each signature before you order the report.
Afterward, keep the signed forms with your hiring records.
Background Check Forms: FAQs
What background check forms does an employer need?
Most employers need a written disclosure and a signed authorization before ordering a report.
Additionally, you need adverse action letters when a report leads to a rejection.
Some states and cities also require their own notices.
Can the background check disclosure be part of the job application?
No. The FTC says the notice must be in writing and in a stand-alone format.
Therefore, give it as a separate document, not inside the application.
Can applicants sign background check forms electronically?
Yes, for most forms.
For example, our sample acknowledgment and authorization supports written or electronic consent.
However, the PSP form and Form SSA-89 need a wet signature.
Which forms do I need before ordering driving records?
Every employer completes the Affidavit of Intended Use and the Compliance Addendum.
In addition, Pennsylvania records need PennDOT form DL-9105 once per employer.
Finally, a PSP record needs the FMCSA disclosure and authorization form.
Can I use these sample background check forms as they are?
They are a starting point, not legal advice.
Moreover, each state or city may require different wording.
Consequently, consult legal counsel before you use any form.
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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.