Background Check Form - Free Download
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Human Resources
School:__
HRONLY:
Rec’don_______________ Enteredon:_________________ SenttoSchoolon:________________
BACKGROUND CHECK FORM
Please be advised that your employment is contingent upon successful completion of this background check.
I prefer to submit my information online directly to Pepperdine’s background screening company.
Please email my secure login information to this email address: ________________________.
(if you prefer to submit your information online, you do not need to complete the information below)
EMPLOYEE INFORMATION
First Name: Middle: Last Name:
Other Names Used:
Years Used:
Current Address: Since (dates): (MM/YY)
Social Security Number: Date of Birth: Gender: Daytime Phone Number:
Male Female
Driver’s License Number: State of Issuance: Email Address:
EMPLOYMENT HISTORY (two most recent)
1.
Company/Employer Name: Dates of Employment:
(MM/YY-MM/YY)
If this is your present employer, may we contact this employer Position/Title:
Yes No
Employer City & State: Employer Phone Number:
2
Company/Employer Name:
Dates of Employment:
(MM/YY-MM/YY)
If this is your present employer, may we contact this employer Position/Title:
Yes No
Employer City & State: Employer Phone Number:
EDUCATION (Highest Degree Earned)
School: Dates Attended: (MM/YY-MM/YY) School Phone:
City: State: Degree Earned:
Major:
PROFESSIONAL LICENSES (including BAR affiliation)
Type of License: License #: State:
Submit to Center for Human Resources, Attn: Larissa Robinson, or fax to 310-506-4839
