Reference Check Waiver Form

Our current employment application has a statement under each "previous employer" section that asks if it's ok if we contact the employer for a reference. This has traditionally been left up to the supervisors to complete. We do not provide or ask for a general reference waiver. We now would like to complete  more thorough reference check on applicants to include education, drivers license status, previous employment (basic employment information like dates, reason for leaving, salary, job duties...) We will be doing this in house staying away from using third party consumer reporting agencies and hopefully the requirements of the FCRA. Does anyone have any tips/ideas or a sample reference waiver that is all inclusive of previous employment, drivers license status, educational verification, and criminal history?


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    This is the title of our waiver. We use this for employment purposes so that our in house investigators may complete background checks (not using a third party). Is this in the arena of what you are looking for?

  • Thank you yes, this is where I want to be headed. I have created a draft waiver that reads as follows:

     REFERENCE INFORMATION WAIVER FORM<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

    I, ______________________________, have applied for a position with the <?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" />"great place to work".

                (Print Name)

    In order that they may better evaluate my qualifications I wish that they be fully advised of my records with you. I understand this reference check may encompass previous employment, education/certifications, driver’s license status, and criminal history check.


    I hereby respectfully request that you furnish the necessary requested information and authorize its release without penalty or liability due to an invasion of privacy or civil rights or any other claim based upon the release of the information.



                Signature of Applicant                                                    Date

     I'm curious about additional language or items to be aware of or include that people have experienced. I initially anticipate our background checks to be somewhat minimal in nature with HR responsible for calling and verifying previous employment info such as dates of employment, reason for leaving, salary etc... A verification of degrees and/or licenses as well as checking the educational institutions acredditation. Drivers license validity in terms of suspended or valid, and a criminal history check based off of state court search information. In searching the web I see some states provide this information for free, some charge.

  • Ok. Send me an email address and I will send you my form. By the way, I have the potential new hire notarize the authorization form. It is quite detailed because it is designed for emergency services applicants.
  • Ok I'll work up the form and send it to you.
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