Get IN Touch BACKGROUND CHECK Please complete the form below so that we may begin your background check process Background Check AUTHORIZATION OF BACKGROUND INVESTIGATION By this form's submission I consent to the preparation of background reports by a consumer reporting agency such as Janus Investigations, and to the release of such background reports to O'Donnell Impact Windows and Storm Protection and its designated representatives and agents, for the purpose of assisting O'Donnell Impact Windows and Storm Protection in making a determination as to my eligibility for employment (including independant contractor assignments, as applicable) promotion, retention or for other lawful employment purposes. I understand that if O'Donnell Impact Windows and Storm Protection hires me or contracts for my services, my consent will apply, and O'Donnell Impact Windows and Storm Protection may obtain background reports, throughout my employment or contract period. I understand that information contained in my employment or contractor application, or otherwise disclosed by me before or during my employment or contract assignment, if any, may be used for the purpose of obtaining and evaluating background reports on me. I also understand that nothing herein shall be construed as an offer of employment or contract for services. I hereby authorize law enforcement agencies, learning institutions (including public and private schools and universities), information service bureaus, record/data repositories, courts (federal, state and local), motor vehicle record agencies, my past or present employers, the military, worker's compensation agencies, and other individuals and sources to furnish any and all information on me that is requested by the consumer reporting agency. I understand that I may be required to take a drug test before or during employment. By this form's submission I also certify the information I provided on and in connection with this form to be, accurate, and complete. I agree that this form in original, faxed, photocopied or electronically submitted form will be valid for any background reports that may be requested by or on behalf of O'Donnell Impact Windows and Storm Protection.Name First Last Email Social Security NumberOther Names or Social Security Numbers UsedCurrent Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Please list all addresses for the past 7 years.Past Address 1Dates Resided TherePast Address 2Dates Resided TherePast Address 3Dates Resided TherePast Address 4Dates Resided TherePast Address 5Dates Resided ThereDriver's License #Issuing StatePhone NumberDate of Birth Have you ever been convicted of a crime?This includes but is not limited to please of guilty, nollo contendre, no contest, adjudication withheld, and pre trial intervention programs.YesNoIf you have been convicted of a crime, please list all offenses, including traffic and/or criminal.Please use the following format: Year | Offense | City | County | StateSignatureBy typing my name above, I understand and agree that this form of electronic signature has the same legal force and affect as a manual signature.Date May we contact your current employer?YesNo Δ
