Fillable Mda Director Position Background Check Consent Form printable pdf download

Mda Director Position Background Check Consent Form

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BACKGROUND CHECK

AUTHORIZATION

As part of the hiring process, you should be aware that the Michigan Department of

Agriculture will conduct a background screening, which will include a Michigan State

Police LIEN check. All new state employees must also pass a drug test as a condition

of employment. We have the right to refuse or terminate employment based upon

failure to successfully pass a background screening or drug test.

This information is confidential. Disclosure of confidential information is protected by

the Federal Privacy Act.

AGREEMENT

I have read the above paragraph and fully understand it. I hereby consent to allow the

Michigan Department of Agriculture to conduct a background check.

Name _____________________________________________Birth Date___________

Address_______________________________________________________________

Drivers Lic. #______________________________Social Sec. #__________________

Signature__________________________________________Date________________

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Mda Director Position Background Check Consent Form

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