Purpose for Requesting Background Checks
Which Services are Requested?
Permissible Purpose Certification
Applicant Authorization Confirmation
Checkr will send each applicant a secure link to complete their authorization and provide any required information (including SSN) directly to the screening provider.
Adverse Action Acknowledgment
Payment & Service Terms
All services are prepaid. You will receive payment instructions after this form is submitted. Services will not be initiated until payment is confirmed.
Certification & Electronic Signature
Authorized Representative – Full Legal Name
By submitting this form, I certify that all information provided is accurate and that I agree to comply with all applicable federal and state laws regarding background screening.

Business Hours: Monday–Thursday, 6:00–9:00 PM | Saturday, 9:00 AM–1:00 PM (Mountain Time)
Other times available by appointment. Most applications are accepted via email.