Background Checks Permission Form

First Name

Middle Name

Last Name

Other names used including Maiden Name

Phone

Current Address

Previous Address

Date of Birth

City of Birth

State of Birth

Social Security Number

Driver's License Number

Driver's License State

Do you have any known criminal records including driving vioations? If yes, please give details

CONSUMER REPORT / INVESTIGATIVE CONSUMER REPORT AUTHORIZATION DOCUMENT

By signing below, I authorize Williamsburg Nanny Agency (the “Company”) to order consumer reports and investigative consumer reports from Datasource, Inc. (“Datasource”), 1200 NW South Outer Road, Suite 319, Blue Springs, MO 64015, (877) 577-3832, to the extent allowed by law. I understand that, to the extent allowed by law, the Company may rely on this authorization to order additional consumer reports and investigative consumer reports from Datasource without asking me for my authorization again during any period of employment.

For the specific purpose of preparing consumer reports and investigative consumer reports for the Company, and subject to all laws protecting my privacy, I authorize the following to disclose to Datasource the information needed to compile the reports: law enforcement and all other federal, state, and local agencies; all courts; my past or present employers; learning institutions, including colleges and universities; credit bureaus; and motor vehicle records agencies.

I accept terms & conditions

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