Background Check Authorization

Background Check Authorization and Disclosure

By completing this form, I hereby authorize Morningside Nannies and/or its agents to make an independent investigation of my background, references, character, past employment, education, credit history, criminal or police records, including those maintained by both public and private organizations and all public records, for the purpose of confirming the information contained on my employment application and/or obtaining information which may be material of my qualifications for employment now and, if applicable, during the tenure of my employment with Morningside Nannies or with any employer introduced to me by Morningside Nannies. I release Morningside Nannies and/or its agents and any person or entity, providing information pursuant to these authorization, from any and all liabilities, claims or law suits in regards to the information obtained from any and all of the above referenced sources used. I authorize a photocopy or fax copy for this document to be considered as effective and valid as the original. The following is my true and complete legal name and all information is true and correct to the best of my knowledge.

Full Legal Name - As listed on Driver’s License (First, Middle, Last)
Permanent Street Address (PO boxes not allowed)
Street Address Address Line 2 City State ZIP Code
County
List All Other Names & Addresses used during the last 7 years:
City State Zip Name Used Dates
*Within the past seven (7) years have you been convicted of a crime?
- Yes
- No
If yes, please explain the circumstances of the conviction (s):
*A conviction does not automatically eliminate you from consideration. We will consider factors such as your age at this time of the conviction or how long ago it occurred or the nature of the offense.
Date of Birth
Month
Day
Year

This information is required for identification purposes only, and is no manner used as a qualification for employment. Morningside Nannies does not Discriminate on the basis of Sex, Race, Religion, Age, Handicap or National Origin.
Social Security Number
Driver’s License Number
Driver’s License State
Today's Date
MM slash DD slash YYYY
Signature
I warrant the truthfulness of the information provided in this application.
- I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance

City	State	Zip	Name Used	Dates