Background Check Agreement

Personal Information
I understand if I am offered a position with Aquinas Carondelet Home Health, a background check will need to be completed. Once I have received an offer letter and replied back with my acceptance, I agree to have Aquinas Carondelet Home Health complete my background check and license verification (if applicable).
Name*
First Last
Any other legal names you have been known by:
Social Security Number*
Date of Birth*
MM slash DD slash YYYY
***Clinical Applicants Only***
Exact Name on Professional License
First Last
License Number
State
Applicant's Typed Signature
Today's Date
MM slash DD slash YYYY