ASU Background Check Form

Submitted By:
Department:
Department Phone Number:
Hiring Manager:
Proposed Start Date:
Candidate Name:
ASU ID or Last 4 Digits of SSN:
Position Number:
Position Title:
Email Address:
Phone Number: (Daytime)
Phone Number: (Evening)
International: Yes No
If yes, what country?
Is licensure such as CPA, RN, or PHR, etc. required for this position? Yes No
If yes, what type?
Notes or Additional Information:

By clicking the ‘Submit to HR’ button, I have verified that this individual has not retired from the Arkansas Teacher Retirement System within the last 180 days.  I understand that hiring a recent retiree of ATRS will jeopardize the individual’s retirement benefits by returning to work at ASU prior to the 180 day elimination period.
 

For questions, please contact the Office of Human Resources at 972-3454.