RWI Transportation LLC Recruiting

Employment Application

Background Check Release Form

PER FCRA: Submitting this form authorizes a background investigation. 2) You may not be hired or your employment continued based on our report. 3) You will be told if that is the intent. 4) You can view the report and dispute items you feel are erroneous with us or the source.

(All fields marked with * are required)


* Last Name:
* First Name:
Middle Initial:
* SS Number:
* Email:
* Present Address:
* City:
* State:
* Zip:
* County:
* Years:
* Prior Address:
* City:
* State:
* Zip:
* County:
* Years:
Other Prior County(1):
Other Prior State:
Other Prior County(2):
Other Prior State:
Other Prior City:
Other Prior State:
* Full Date of Birth:
Note: Year of Birth used for identification only
* Race:
(TBI, IN State Police and FDLE require race to run these reports)
* Driver License#:
* Driver License State:
* Maiden/Other Names Used:
* Male/Female:
LIST ALL CONVICTIONS INCLUDING TRAFFIC
Year:
Nature of Offense:
Resolution:
Where (City/State):
Misdemeanor or Felony:
Year:
Nature of Offense:
Resolution:
Where (City/State):
Misdemeanor or Felony:
Year:
Nature of Offense:
Resolution:
Where (City/State):
Misdemeanor or Felony:
Year:
Nature of Offense:
Resolution:
Where (City/State):
Misdemeanor or Felony:
Year:
Nature of Offense:
Resolution:
Where (City/State):
Misdemeanor or Felony:
Year:
Nature of Offense:
Resolution:
Where (City/State):
Misdemeanor or Felony:
By submitting this, I hereby authorize the release to Background Bureau, Inc. (BBI) an independent pre-employment screening agency, of any information held by any parties regarding my prior employment, criminal, credit, driving, workers comp. and educational history as well as information regarding my general character and reputation. I release any providers of such information of any liability for providing same. I understand the information may be reviewed initially and periodically by BBI and reported to my prospective/actual employer. I agree falsification may make me ineligible for employment or subject to immediate dismissal, if hired. I further acknowledge that BBI is relying on third party information and I therefore release BBI, my prospective employer, and their respective owners, officers, agents and employees from any and all liability arising out of errors or omissions. If not hired, I understand I do have certain rights under FCRA laws.