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Background Check Authorization Form
Background Check Authorization Form
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Applicant Information
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Step
1
of 4
Applicant Information
Full Legal Name (First, Middle, Last)
*
First
Middle
Last
Date of Birth
*
Social Security Number
*
Please follow this format: 123-12-1234
Driver's License / State ID Information
Driver's License / State ID Number
*
State of Issue
*
Expiration Date
*
Residency Information
Have You Lived At Your Current Home Address For More Than 5 Years?
Yes
No
Current Home Address
*
Address Line 1
Address Line 2
City
--- Select state ---
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State
Zip Code
Previous Home Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
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Mobile Phone Number
*
Alternative Phone Number (Work, Home, etc.)
Email Address
*
Next
Current Occupation / Job Title
*
Business/Salon Name (If Applicable)
Years In Operation
*
Types Of Services Provided
*
Next
Home Provided Driver's
Background Check Authorization
I understand that Concept Salons requires a background screening as part of the application process. This screening may include, but is not limited to: verification of identity, social security trace, criminal history search, sex offender registry, employment verification, and professional license verification. By signing below, I authorize Concept Salons and its designated agents to obtain any background information necessary to evaluate my application to lease a salon suite. I understand that all information obtained will be kept confidential and used solely for rental consideration.
Signature
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Clear Signature
Print Name
*
Today's Date
*
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