This Authorization, Waiver, and Release of Liability for Employment-Related
Investigation is used by an employer to request permission from a job applicant to allow
the employer to conduct a background check pursuant to California and federal law.
The background check includes a review by the company or a third party of the
applicant’s references, records, and credit. This agreement is ideal for small
businesses that want to obtain permission from job applicants to conduct such
___________ [Instruction: Insert Company Name]
___________ [Instruction: Insert Company Address 1]
___________ [Instruction: Insert Company Address 2]
___________ [Instruction: Insert Date]
___________ [Instruction: Insert Applicant Name]
___________ [Instruction: Insert Address 1]
___________ [Instruction: Insert Address 2]
Re: Applicant Background Check/Credit Report
Dear ___________ [Instruction: Insert Applicant Name],
We at ___________ [Instruction: Insert Company Name], are glad that you have
applied for the position of ___________ [Instruction: Insert Position]. In connection with our
review of your application, we would like to contact your personal references, professional
references, educational institutions, and other companies and/or people that you have listed on
employment application, resume, references and/or curriculum vitae (individually and
collectively, the “References”), all in accordance with Company’s reasonable employee
background check procedure and screening process. Your signature below authorizes us to
speak to the References and authorizes each Reference to disclose to us, in good faith, any
information they may have regarding your qualifications and fitness for employment.
In addition, we and/or our designated agent (including any consumer reporting agency),
would like to conduct a background investigation of your personal history, to obtain and review
your criminal and civil court records, to investigate any action related to your employment
(collectively the “Records”), all to the full extent permitted by law. You understand that the
nature and scope of these inquiries into the Records may include (but are not limited to):
verifying and inspecting any lawfully available records or information pertaining to work
history, education, worker’s compensation claims, criminal and civil court related actions,
driving history (including traffic related offenses), personal financial status, and any other
information available from any public or otherwise documented record. Your signature below
authorizes us to review and investigate the Records and utilize the Records in determining your
qualifications and fitness for employment
In connection with our standard background check procedure, we would also like to run a
credit report, in accordance with the provisions of the Fair Credit Reporting Act, 15 U.S.C.
§§1681 et seq. (“FCRA”) and the Consumer Credit Reporting Agencies Act, CA Civil Code
§1785 (“CCRAA”). A credit check is being requested because the position that you are applying
for is ___________ [Instruction: Insert Why Credit Check Can Legally be Performed].
With your consent, the credit report will be performed by ___________ [Instruction: Insert
Credit Report Company], www.___________.com [Instruction: Insert web address of
Credit Report Company]. Information in the credit report may be used to make an adverse
decision about your fitness for the position. You will be informed if any information in your
credit report leads to such an adverse decision. If you would like free a copy of the credit report,
please indicate so in the check box below. Your signature below indicates that you have been
advised of your rights under applicable law and consent to our hiring of ___________
[Instruction: Insert Credit Report Company] to perform a credit report.
Please signify your acceptance to the foregoing terms by signing and returning this letter
to me no later than ___________ [Instruction: Insert Date]. Your signature indicates that you
agree to hold us and our officers, employees, or related personnel, harmless from any and all
liability for claims, liabilities, causes of action, damages, judgments, attorneys’ fees, court costs,
and expenses or damages of whatever kind, related to the exchange of such reasonable and
necessary information disclosed to us during the course of the employment background check,
screening process and credit report.
Very Truly Yours,
________________ [Instruction: sign]
___________ [Instruction: Insert Name of
___________ [Instruction: Insert Title]
I hereby accept each of the terms and conditions set forth in this letter regarding the employment
background check, the References, the Records, the screening process and credit report.
Signature of Candidate
By checking this checkbox, I further indicate that I would like a free copy of the credit
report run performed by ___________ [Instruction: Insert Credit Report Company].