Background Checks Permission Form

First Name

Middle Name

Last Name

Other names used including Maiden Name

Phone

Current Address

Previous Address

Date of Birth

City of Birth

State of Birth

Social Security Number

Driver's License Number

Driver's License State

Do you have any known criminal records including driving vioations? If yes, please give details

Authorization -

By checking the box below you authorize:

(a) Williamsburg Nanny Agency (WNA) to request information about you from any public or private information source.

(b) anyone to provide information about you to WNA.

(d) WNA to share those reports with WNA for legitimate business purposes related to your employment, specifically with clients who have offered you a permanent nanny position.

(e)You acknowledge receiving the Federal Trade Commission’s “Summary of Your Rights under the Fair Credit Reporting Act.”

(f)You acknowledge that fax, image, or copy of this authorization is as valid as the original.

You make this authorization to be valid for as long as you are an applicant or employee with the WNA.

I accept terms & conditions

Thanks for submitting!