Background Check Authorization Form

Sep 17, 2026

Upload by Kyle

Background Check Authorization Form collects personal identification details needed for conducting employment or volunteer background checks, including legal name, aliases, address, date of birth, Social Security number, contact information, and related disclosure answers. It authorizes the School District to investigate employment history and request information from prior employers and government agencies. The form addresses criminal charge or conviction disclosures, non-discrimination policy statements, certification of truthfulness, signature authorization for third-party reporting, and office-use position information.

LanguageEnglish

CategoryForms

FormatPDF

Pages1

AccessFree to download

Background Check Authorization

Applicant information and required disclosures

Authorization, certification, and non-discrimination

Signature and office use only

SERVE WITH PASSION TO IGNITE CREATIVITY, INNOVATION, AND EXCELLENCE Background Check Authorization Legal Name: First, Middle, Last; Alias Address: Male Female Date of Birth Social Security Number Email Address: Phone Number: *Note: The above data is required to do a background check. This form will remain with Human Resources. Is this for a volunteer application? Yes No If Yes, Teacher Name: Have you ever pleaded guilty to or been convicted of a misdemeanor or felony? Yes No Do you have any pending criminal charges? Yes No If yes to either of the above, please explain. Include date(s), location of court, nature and place of charge or conviction and disposition of the case: | | | --- | | | | | I authorize the School District to investigate my personal employment history and I authorize any former employers, person, ﬁrm, corporation, or government agency to give the School District any information regarding my employment history. Background checks are run by the District upon applying and when deemed necessary. Criminal charges or convictions are not an automatic bar to service. The District will consider the nature of the offense, date of the offense, and relationship between the offense and the position. I hereby certify that the above information to the best of my knowledge is true, accurate and complete. Any misrepresentations or willful omissions of facts shall be sufﬁcient cause for disqualiﬁcation from consideration, or if employed, my immediate dismissal. I further agree to abide by all rules, regulations and policies of the District. I hereby authorize the School District of West Salem to utilize third party agencies to collect reports by contacting law enforcement agencies, city, state, county and federal courts to release information about my background including, but not limited to, information about my criminal record. This release shall remain in effect for the length of my service. I understand I have the right to obtain a copy of background check reports if the written request is made within 60 days of signature below. The Board does not discriminate in employment on the basis of race, color, national origin, age, sex (including gender status, change of sex, sexual orientation, or gender identity), pregnancy, creed or religion, genetic information, handicap or disability, marital status, citizenship status, veteran status, military service (as deﬁned in 111.32 Wis. Stats.), ancestry, arrest record, conviction record, use or non-use of lawful products off the District’s premises during non-working hours, declining to attend an employer sponsored meeting or to participate in any communication with the employer about religious matters or political matters, or any other legally protected category in its programs and activities including employment opportunities. Signature * An electronic signature serves as a valid signature Date Ofﬁce Use Only: Position to ﬁll RYANG. RIEBER, SUPERINTENDENT 608.786.0700 405 EAST HAMLIN ST. WEST SALEM, WI 54669

FAQs

What personal information is required on this authorization form?

Legal name and alias, address, sex, date of birth, Social Security number, email address, and phone number are required to perform the background check.

What does the applicant authorize the school district to do?

The applicant authorizes the school district to investigate personal employment history and to obtain information from former employers and government agencies, including third-party agencies collecting reports.

Does a criminal conviction automatically disqualify a candidate?

Criminal charges or convictions are not an automatic bar; the district considers the nature of the offense, the date, and how it relates to the position.

Sep 17, 2026

Upload by Kyle