Background Check Disclosure and Release Form

Background Check Disclosure

By submitting this release form, I agree to the following terms:

• I understand that Hawkeye Community College and its agents may conduct an investigation of my personal information as part of the application process for acceptance into a Health and Human Services program at Hawkeye Community College.

• I understand that this investigation may include, but is not limited to:

  • Criminal history records from private, city, state, and federal sources
  • Social security number and/or fingerprint trace
  • Residence history
  • Sex offender and child/dependent adult abuse registries.

• I understand these records may be used to determine my eligibility and acceptance into Hawkeye's healthcare, police science, and early childhood programs; plus clinical agency and practicum activities.

• I authorize without reservation the full release of these records to Hawkeye Community College and/or its agents contacted to obtain information.

• I understand that there is a $15, non-refundable, student fee to process the background check.

• I release and discharge Hawkeye Community College and all of its agents and associates any expenses, losses, damages, liabilities, or any other charges or complaints for the investigative process.

• I authorize the full release of the information described above, without reservation, throughout the duration of my enrollment at Hawkeye Community College.

• I certify that, to the best of my knowledge, all information on this release form is correct.

• I understand any false statements will be considered just cause for dismissal.

• I understand that I can request that Hawkeye Community College supply me with a copy of my report as pursuant to my rights covered under the Fair Credit Reporting Act.