Background Checks | Panther Security and Investigations

Background Check Intake Form

Please fill out application to the best of your abilities.

Job ID

State Abbreviation - MM/YY of Submission

First, Middle, and Last Name

Other Names

Date of Birth required

Phone Number

Social Security Number

###-##-####

Drivers License & State

Full Address

Employment & Education History

Current Employer

Position/Title

Employer Address

Highest Level of Education Completed

Name of School/Institution

Graduation Year

Criminal History

If yes, provide details (Offense, Date, Location, Disposition)

Have you ever been convicted of a felony or misdemeanor?

YesNo

Are you currently on probation or parole?

YesNo

Do you have any pending criminal charges?

YesNo

If yes, provide details

I hereby authorize Landslide Political (hereafter referred to as "Company") and/or its agents, Panther Security and Investigations LLC, to conduct investigations, whether the records are of a public, private, or confidential nature, at any time I am enrolled in, assigned to, volunteering with, or employed by this Company.

I understand these investigations might include, but are not limited to, searches of educational institutions attended; state driving records; financial or credit institutions; employment records, including work history, efficiency ratings, complaints, and grievances filed by or against me; records and recollections of attorneys-at-law or other counsel, whether representing me or any other person (in either a civil or criminal case in which I have been involved)

I understand that these searches may be used to determine eligibility under Company policies. Therefore, I authorize and consent to the full release of records (either orally or in writing) to the authorized representatives of the Company. I understand that according to the Federal Fair Credit Reporting Act, I am entitled to know whether employment was denied based on the information obtained. Upon written request, I may receive a disclosure of the background report.

I fully understand it's contents and authorize the background verification

Today's Date required

Background Check Intake Form

Employment & Education History

Criminal History

Consent and Attestation - Authorization for Background Check