A candidate-facing consent form for background screening that sets out what the check may cover, how data is handled, and the candidate's rights. Use it before ordering any screening.
This form records your consent for Company name (the "Company") to carry out a background check in connection with your application for the position of Position applied for. It explains what the check may cover, how your information will be handled, and the rights you keep throughout the process. Please read it in full before signing.
Depending on the role, the check may cover some or all of the following. The Company requests only the checks it considers relevant to the position:
The Company may engage a specialist screening provider to perform some or all of the check. If a provider is used, it acts only on the Company's instructions and under confidentiality obligations. Information gathered is used solely to assess your suitability for the position, is shared only with the people involved in that decision, and is stored securely and retained no longer than needed for the hiring decision and any record-keeping the Company reasonably requires. Your information is never sold or used for unrelated purposes.
Throughout the screening process you keep the following rights:
This consent covers the checks described above for this application only. It remains valid for the duration of the hiring process for this position and, if you are hired, for the completion of any checks already underway at your start date. You may withdraw consent at any time by writing to the Company; withdrawal does not affect checks already completed.
Provide the details below exactly as they appear on your identity documents. Where an item does not apply, write "none".
By signing below, I confirm that I have read and understood this form, that the information I have provided is accurate, and that I consent to the Company and its screening provider carrying out the checks described above for this application. I understand my rights as set out in section 3, including my right to dispute inaccurate information and to withdraw this consent in writing.
Candidate signature: ✍ Candidate signature Date: Signature date
Highlighted fields are filled in when you customize and send this document on Diiirect.
Jurisdiction note
Background screening is heavily regulated and the rules differ widely by jurisdiction: what may be checked (especially criminal and credit history), consent and disclosure formalities, and the steps required before acting on adverse findings all vary. Have local counsel review this form and your screening process before use.
Not legal advice
This template is provided for general informational purposes only and is not legal advice. Laws differ by jurisdiction and change over time — have a qualified professional review any document before you rely on it.
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