Background Check

Certified Agent Background Check Disclosure and Authorization Form

Application Details

Company Name: Certified Artist LLC

Position Applied For: Certified Agent

Date of Application

1. Background Investigation Disclosure

Certified Artist LLC may obtain consumer reports for employment purposes including character, reputation, employment history, education verification, licenses, driving records, references, and credit history where legally permitted.

Criminal history records (federal, state, local)
Employment verification
Education verification
Professional license checks
Driving records
Reference checks
Credit history (if applicable)

2. State-Specific Notices

California — Request copy of report

Minnesota — Request copy of report

Oklahoma — Request copy of report

3. Authorization

I authorize Certified Artist LLC to obtain consumer reports and investigative reports during employment and for hiring purposes. I release all parties from liability for providing information.

4. Applicant Rights (FCRA)

Be informed of adverse information usage
Access your consumer file
Dispute incorrect data
Obtain free reports under conditions

Applicant Information

Full Legal Name

Other Names Used

Date of Birth

SSN (Last 4 Digits)

Current Address

Previous Addresses (Last 7 Years)

Phone Number

Email Address

Date

Printed Name

For Employer Use Only

Date Request Sent

Background Check Provider

Results Received

Notes