BOYS & GIRLS CLUBS OF THE ANTELOPE VALLEY
BACKGROUND VERIFICATION AUTHORIZATION
APPLICANT – PLEASE COMPLETE THE SECTION BELOW & SIGN
(Only Human Resources views the information below – it is not made available to hiring supervisors or others in the organization. If you are not selected for the position, this form is shredded and not retained in our files.)
I hereby authorize Boys & Girls Clubs of The Antelope Valley to make an independent investigation of my background, references, character, past employment, education, criminal or police records, including those maintained by both public and private organizations and all public records for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for employment.
I release Boys & Girls Clubs of The Antelope Valley and any person or entity which provides information pursuant to this authorization, from any and all liabilities, claims or law suits in regard to the information obtained from any and all of the above referenced sources.
I understand that any offer of employment is contingent on a satisfactory background investigation. I also understand that this form will not be kept in my permanent file if I am employed. I certify that the following is my true and complete legal name and all information contained herein is true and correct to the best of my knowledge.
____________________________ ___________________________
Employee Date
Boys & Girls Club Antelope Valley, P.O. Box 10047, lANCASTER, ca 93584 (661) 951-1013 FAX (661) 951-1322 hr@avbgc.org Club sites in Palmdale, Lancaster, Mojave, California City & Lake Isabella
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THIS SPACE FOR HUMAN RESOURCES USE ONLY FROM: Boys & Girls Clubs of ___________ ACCOUNT NUMBER: Requester: _____________________ Date Requested: __________________ Phone: ( ) Number of pages: _________________ Fax: ( ) PER COMPONENT SELECTION: [ ] Criminal records -- Search felony criminal records (statewide where available) at all address for 7 years. [ ] Statewide Repository -- Search statewide database for felony & misdemeanor criminal records (where available). [ ] National Criminal File Search [ ] Sexual Offender Database – *Please note which state(s) you want reported: ________________________ [ ] National Credit File -- Search national credit file for employment. [ ] Motor Vehicle Record -- DL#___________________________________________ State ________________ [ ] Education – Please indicate school on the application, attach application. |