Clear Form
BACKGROUND CHECK USC SCHOOL OF MEDICINE To: Stephanie, Dora, Glenda, Krista, Kim (circle one)
From: ______________________ Department: _____________________
Applicant Name: ______________________________________________ Account Number: _________________________________52070_______ Handling Funds: yes no
Place an X next to the type of verification/background check to be performed:
South Carolina Criminal Background Check (SLED) ------------------------- OR -------------------------------Criminal Conviction Record – County, State and Federal Driver’s license verification and driving record check
Credit Check (only if handling University funds)
Social Security Number verification and fraud detection
Verification of prior employment (not required if performed by department)
Verification of education and other credentials to include professional license verification (not required if performed by department)
Fax this cover sheet and the signed Acknowledgement /Authorization Form to the USC School of Medicine HR Office at 803-252-9817.