Background Check Authorization

    Date Former Name Used Until
    Date Former Name Used Until
    Current Address
    Current Address
    Current Address Since
    Current Address Since
    Previous Address
    Previous Address
    Previous Address From
    Previous Address From
    Birthdate
    Birthdate
    The information contained in this application is correct to the best of my knowledge.  I hereby authorize Alvernia Unversity and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment and/or volunteer purposes.  I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to the following areas: verification of social security number; current and previous residences; and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records.

    I further authorize any individual, company, firm, corporation, or public agency to divulge any and all information, verbal or written, pertaining to me, to Alvernia University or its agents.  I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources.

    Alvernia University and its designated agents and representatives shall maintain all information received from this authorization in a confidential manner in order to protect the applicant's personal information, including, but not limited to, addresses, social security numbers, and dates of birth.
    Signature
    Signature
    Notice to California, Minnesota, and Oklahoma Residents Only:
    Please check the box below if you wish to receive a copy of a consumer report that is requested.
    Notice to California, Minnesota, and Oklahoma Residents Only:
    Please check the box below if you wish to receive a copy of a consumer report that is requested.