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3- Self Report
see Disclosure Authorization Form

Background Check Disclosure and Authorization

In the interest of maintaining the safety and security of our customers, employees and property, ALASKA PACIFIC UNIVERSITY (the “Company”) will order a “consumer report” (a background report) or “investigative consumer report” on you in connection with your employment application, and if you are hired, or if you already work for the Company, may order additional background report on you for employment purpose.

The above link provided in this form is for you. The Fair Credit Reporting Act gives you specific rights in dealing with consumer reporting agencies. Please take time to open up the link to clearly understand these rights.


Authorization for Background Checks

After carefully reading this Background Check Disclosure and Authorization form, I authorize the Company to order my background report.

* First Name  
Middle Name
* Last Name  
Maiden/Other Names
Years Used:

Background Check Information

This information requested below is solely collected for the purpose of aiding the Company in running a background check in connection with your application for employment.

   Date of Birth  
   Social Security Number  (for identification purposes only)  
   Driver's License Number    State Issuing License    Name on License
   Present Street Address
   City    State    Zip  
List all addresses within the past seven years, including: street address, city, state, zip code, and to/from dates.

*  I understand that false information, misrepresentations and omissions may disqualify me from consideration for employment, or, if I am hired or already work for the company, that I may be disciplined, up to and including termination.