Background Check Authorization Form

Please read and sign this form in the signing field provided below. Your written authorization is necessary to complete the application process and the 90-day probationary work period. 

I, , hereby authorize TPK, LLC to investigate my background and qualifications to evaluate whether I am qualified for the position for which I am applying or currently hold within the 90-day probationary period. I understand that TPK, LLC will utilize an outside firm or firms to assist in checking such information. I authorize such an investigation by information services and external entities of the company's choice. I also understand that I may withhold my permission and that in such a case, no investigation will be done, my employment application will not be processed further, and/or my 90-day probationary period will terminate. 

Law enforcement agencies require the following information for identification purposes when checking public records. It is confidential and will not be used for any other purpose.

Date of Birth:  

Social Security Number:

Previous Names (if any):

Current Home Address:

Driver's License Number:

Driver's License State:

Name Listed on Driver's License:

Leave this empty:

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Signed by Erik Hughes
Signed On: September 15, 2022

Signature Certificate
Document name: Background Check Authorization Form
lock iconUnique Document ID: 4832738ead131dab821088a21ac9e0f2d2c1c67e
Timestamp Audit
September 15, 2022 9:49 am ESTBackground Check Authorization Form Uploaded by Erik Hughes - IP
September 15, 2022 12:23 pm ESTKim Phelps - added by Erik Hughes - as a CC'd Recipient Ip: