Background Check Disclosure &
Authorization Form
As a condition of employment, Texas Tech University System and its components require pre-employment background checks on new
employees. Current employees, who are selected from promotion or reclassification including direct appointments, require a new
background check prior to the promotion or reclassification becoming effective. All background checks will include a criminal check,
and may include a credit check, drug and alcohol test, and/or fingerprinting as determined by each position.
Pre-Employ.com, Inc. will obtain reports for Texas Tech University. Pre-Employ.com, Inc. is located at 2301 Balls Ferry Road, Anderson,
California 96007, and can be contacted at 800-300-1821. The reports may contain information bearing on your character, general
reputation, personal characteristics, and mode of living. The types of information that may be obtained include, but are not limited to
the following:
Social Security Number Verifications
Criminal Records Check
Public Court Records Checks
Driving Records Checks
Licensing and Certification Records Checks
Sex Offender Registration
Credit Check
A summary of your rights under the Fair Credit Reporting Act will be provided to you. You may request more information about the
nature and scope of any investigative consumer reports by contacting:
TTU HUMAN RESOURCES
BOX 41093 LUBBOCK, TX 79409-1093
Telephone: (806) 742-3851
Applicant Instructions:
Please make every effort to accurately provide all of the information requested on the authorization form. The hiring manager or a
member of Human Resources may contact you for additional information during the verification process. Failure to provide requested
information in a timely manner may prolong or halt your application from being processed.
ATTENTION DEPARTMENT:
Effective September 1st, 2012, a discounted basic background check will be offered for student assistants, graduate assistants, and
teaching assistants, which is run at the discretion of the hiring department. This does not pertain to any student worker positions that
hold a security sensitive level I or II, as stated in OP 70.20. These positions will need to continue to have a regular comprehensive
criminal background check run on them upon hire. Please review the list below to assess if your student worker is a security sensitive
level I or II and will need a comprehensive background check. For any questions, please feel free to contact Human Resources at
742-3851.
Student Workers with Security Sensitive Level I or II
Eligible TTU driver
Handles sensitive information (i.e.
student and employee records)
Handles hazardous
materials
Interacts with minors (i.e. camps)
Section 1: Applicant Information & Authorization (Please print legibly or type)
Name:
First
Middle
Social Security #:
Last
Telephone #:
Date of Birth:
Address:
Street
City
State
Zip
I have carefully read and understand this Disclosure and Authorization form and the attached summary of rights under the Fair Credit
Reporting Act. By my signature below, I consent to the release of investigative reports prepared by a consumer reporting agency,
such as Pre-Employ.com, Inc., to Texas Tech University and its designated representatives and agents. I understand that this
information will be used to determine my eligibility for employment with Texas Tech University.
By my signature below, I certify the information I provided on this form is true and correct. I agree that this Disclosure and
Authorization form in original, faxed, photocopied or electronic form, will be valid for any reports that may be requested by or on
behalf of Texas Tech University.
California, Minnesota, or Oklahoma applicants only: Please check this box if you would like to receive (whenever you have
such right under the applicable state law) a copy of your background report if one is obtained by you on the Company.
Applicant Signature
Date
Section 2: Department Authorization
Applicant's Job Title:
Projected Start Date:
Requesting Department:
Telephone #:
Department Contact:
Email:
Type of Report:
Type of Action:
Basic Report
New Hire
Reclassification
Promotion
Internal Transfer
Student
Additional Reports:
Comprehensive Report
Credit Check (if
requirement of position)
Employee
Security Sensitive Volunteer
Security Sensitive Student (I or II)
Billing Information:
CHART:____________
FUND:____________
ORGN:____________
**ACCOUNT CODE is 7N3**
Billing will occur at the end of the following month.
Please ensure sufficient funds are in FOP listed above.
Account Name:
Date
Finance Manager Signature
FOR HR USE ONLY:
PROG:____________
Entered ____________
Results Received
Return Notice Sent _______________
Email Completed Form To: hr.backgroundcheck@ttu.edu
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