Background Check Authorization Template (US)
Updated on August 9, 2026
Under the Fair Credit Reporting Act, an employer who wants to obtain a consumer report — a background check from a third-party consumer reporting agency — about a job applicant or employee must first give them a clear, written disclosure that a report may be obtained, and get their written authorization. The FTC's own guidance is specific about the disclosure: it must be a stand-alone document. Courts have found employers in violation of that requirement for folding the disclosure into a job application or adding other content, including waivers, to it.
The widely circulated free version of this document does the opposite: it combines personal information, employment history, education history, unconditional criminal-history questions, and the authorization language into one form — and names a fictitious "background check company" directly inside the sentence the applicant signs. This template is a stand-alone disclosure and authorization only. It does not ask criminal-history questions, and it does not collect employment or education history, both of which belong on a separate application form or are obtained by the consumer reporting agency itself.
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Other details
Background Check Disclosure and Authorization
Disclosure
may obtain a consumer report about you from for . This report may include: . This document consists solely of this disclosure and the authorization below.
Applicant identification
- Full legal name:
- Prior names:
- Date of birth:
- Current address:
- Previous address:
Authorization
I have read and understand the disclosure above. I authorize and to obtain a consumer report about me for , using the identifying information I have provided.
Applicant
Date:
Keep the disclosure standalone
The disclosure and authorization in this template contain nothing else — no job application questions, no liability waiver, no unrelated consent. That's a deliberate choice, not a simplification: the FTC's guidance on employment background screening explains that adding other content to the disclosure is one of the most litigated FCRA compliance failures, and it's also one of the easiest to avoid.
Don't ask criminal-history questions on this form
The source document asks applicants directly whether they have been "apprehended, charged or convicted" of a crime, with no acknowledgment that many states and cities restrict when and how criminal-history questions may be asked before a conditional offer of employment — commonly called "ban-the-box" or fair-chance hiring laws. This template does not ask that question at all. If the actual background check returns a criminal record, handling it is a separate, later step — governed by its own notice requirements — not a question on the intake form.
Name the actual consumer reporting agency, not a placeholder
The source template authorizes a fictitious "ABZ Background Check and Investigation Company" by name inside the sentence the applicant signs — a placeholder baked into operative legal text. This template requires the employer to name the actual consumer reporting agency it uses, so the applicant is authorizing a real, identifiable party rather than signing a document with a made-up name in it.
Collect only what identifies the applicant to the reporting agency
A consumer reporting agency needs enough identifying information to run an accurate search — full legal name, any prior names, date of birth, and current and recent addresses are standard. Employment history, education history, and character references are not needed for the disclosure and authorization itself; if the employer wants that information, it belongs on a separate application form, not mixed into this one.
Watch for state-specific additional requirements
Federal FCRA requirements are a floor, not a ceiling. A number of states impose additional disclosure, consent, or copy-of-report requirements on top of federal law for employment background checks. This template gives you a compliant federal starting point; check your specific state's requirements before finalizing your process.
Section-by-section guide
- Disclosure
- A stand-alone statement that a consumer report may be obtained for employment purposes, naming the actual consumer reporting agency.
- Investigative consumer report notice
- An additional notice used only if the report will include information from personal interviews (an investigative consumer report), which carries its own disclosure duty.
- Authorization
- The applicant's written authorization to obtain the report, tied to the identifying information provided.
- Applicant identification
- Full legal name, prior names, date of birth, and current and previous addresses — only what's needed to run an accurate search.
US compliance checklist
This covers the federal baseline; state and local law can add further requirements.
Keep the disclosure a stand-alone document
The required FCRA disclosure must not be combined with a job application or other extraneous content; courts have found employers in violation for doing so.
FTC — What Employment Background Screening Companies Need to Know About the FCRAGet written authorization before ordering the report
The applicant must authorize the report in writing before the employer or its consumer reporting agency obtains it.
Follow pre-adverse and adverse action steps if you plan to act on the report
Before taking an adverse employment action based on a consumer report, federal law requires giving the applicant a copy of the report and a summary of their FCRA rights, and an opportunity to respond, before finalizing the decision.
Check state and local ban-the-box or fair-chance hiring rules
Several states and cities restrict when and how criminal-history questions or actions may occur in the hiring process; confirm the rules in your specific location before asking about or acting on criminal-history information.
Check for additional state background-check disclosure rules
Some states impose disclosure, consent, or report-copy requirements beyond the federal FCRA baseline; confirm your state's specific requirements.
How to complete the form
- Name the reporting agency. Identify the actual consumer reporting agency that will perform the check.
- State the purpose and report types. Specify that the report is for employment purposes and what types of information it will include.
- Collect identifying information. Add the applicant's full legal name, prior names, date of birth, and addresses.
- Obtain signed authorization. Have the applicant sign to authorize the report before it is ordered.
Frequently asked questions
Can the disclosure and authorization be on the same page?
Yes — federal guidance allows the authorization to be included on the same document as the disclosure. What it must not include is anything else: a job application, a liability waiver, or other unrelated content.
Why doesn't this template ask about criminal history?
Because many states and cities restrict when and how criminal-history questions can be asked in the hiring process, and this is a disclosure and authorization form, not the point at which criminal-history information should be evaluated. If the check returns a record, that's handled through the adverse-action process, not a question on this form.
What do I do if the background check reveals something I want to act on?
Before taking any adverse action, give the applicant a copy of the report and a summary of their FCRA rights, and an opportunity to respond, before finalizing your decision.
Do I need the applicant's Social Security number on this form?
Many consumer reporting agencies collect it separately through their own secure intake process rather than on a general HR document. Avoid collecting a full SSN on a form that isn't specifically designed to handle it securely.
Does this template work for every state?
It covers the federal FCRA baseline. Several states add their own disclosure, consent, or notice requirements for employment background checks — confirm your state's specific rules before finalizing your process.
Can I reuse this same authorization for future background checks on the same person?
Treat each check as needing its own authorization tied to its own stated purpose, rather than relying on a single authorization indefinitely. If you plan to run periodic checks during employment, say so explicitly in the disclosure and authorization language rather than assuming a one-time signature covers every future check.
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Disclaimer
This template and guide are for general information only. They are not legal advice, and no attorney or regulator has reviewed or approved them. Background-check disclosure, authorization and adverse-action requirements involve both federal and state law; confirm the specific rules that apply to your organization and location before relying on this document.
