Employment Background Check Application

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Statewide Risk Management, LLC., has been retained by your potential employer to conduct background checks on prospective employees. The Fair Credit Reporting Act requires your consent to permit Statewide Risk Management, LLC., to conduct a background check. Please confirm your consent by completing this form and checking the box on the second page.

Important Note: This is NOT a "State Conduct Verification". If you are applying for a position at a school or district, please ONLY use the "Teacher Application" form on our website: https://statewideriskmanagement.com

Email *

First Name
*

Last Name
*

Home Address
*

Social Security Number
*

Date of Birth *

YYYY

Cell Phone Number
*

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