This form gathers the details needed for screening after a conditional offer, from identity and address history to employment and qualifications, with signed consent for the checks.

Effective Form Templates

This form template is supplied in fully editable MS Word format and can be easily customised and edited. The document uses pre-defined style formatting throughout, with all text in Calibri font for improved readability.
The following document labelling is included in the footer:

• Form number and title
• Information-classification
• Version
• Page number / total pages

alphaZ documents - beautifully designed, tried and tested form templates. No junk, jargon or unnecessary fields. Simple and usable form templates developed over 25 years through practical use in the real world.

Further Reading

Further guidance on recruitment, screening and data protection:

• Recruitment and Selection
• Personnel Records and Data Protection
• Managing Staff and Workers knowledge base

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How to Download

These files are included in the alphaZ subscription. This form is also included in the ISO 9001 Toolkit and the GDPR / Data Protection Toolkit, and in every alphaZ ISO toolkit that covers managing people, so the toolkit route gives you these files plus everything else you need in one download.

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Employee Screening Form Template

This employee screening form collects the details needed for pre-employment checks, completed by the candidate following a conditional offer of employment. It covers personal and identification details, referees, address and employment history, qualifications, driving history and health, medical information, criminal convictions and bankruptcy, with a signed consent declaration for the background checks.

In a management system it supports the screening control in ISO 27001 (Annex A 6.1), and the qualifications and employment history feed competence records under clause 7.2. The form is marked Confidential and its retention is set by the personal data register.

Two Versions in One Download

Both versions share the same structure; choose whether to include the medical questionnaire.

• F-HR17A - the screening details form covering personal details, address and employment history, qualifications, driving history and health, medical conditions, criminal convictions and bankruptcy, with the consent declaration.
• F-HR17B - the same form with an added Medical Questionnaire section asking about disability, any job declined or medical retirement due to health, current medical investigations, recent sickness absence and any history of drug or alcohol dependency or misuse.

Built for Pre-Employment Screening

The form gathers what is needed to carry out background checks in one consented record.

• Captures identity, name history and identification documents for verification.
• Records address and employment history for the last five years, with referees and contacts for references.
• Sets out academic and vocational qualifications and licences to check against the role.
• Covers driving endorsements, collisions and fitness to drive for roles that involve driving.
• Records the candidate's consent to the checks, to contact with referees and to driver record checks.

What's Included in this Employee Screening Form

Both versions follow the numbered sections below, and F-HR17B adds section 6.2.

• 1. Personal Details - name and name history, date and place of birth, nationality, parents' full names, passport and driving licence numbers with country of issue, other identification, and referee details.
• 2. Address Details - current address and the date it started, and previous permanent addresses for the last five years with dates.
• 3. Employment History - last employer and previous employment for the last five years, with dates, address, job title, reason for leaving and a reference contact.
• 4. Qualifications - academic qualifications and vocational qualifications or licences, with issuer, date issued and details.
• 5. Driving History and Health - driving convictions, endorsements and fines, collisions involving an insurer or the police, and yes / no driving health questions on vision, blackouts, medication, other conditions, heart conditions and sleep disorders.
• 6.1 Medical conditions - any medical condition or health issue that could affect the candidate's duties at work.
• 6.2 Medical Questionnaire - disability, a job declined or medical retirement due to health, current investigations, recent sickness absence and drug or alcohol dependency or misuse (F-HR17B only).
• 7. Criminal convictions / Bankruptcy - details of any unspent criminal convictions and of any bankruptcy.
• Consent Declaration - confirmation of accuracy and consent to third party checks, to contact with referees, to retention for background checks and to driver record checks, with signature and date.
• Record Retention Summary - a table to record the protection and retention of each part of the completed form.

Who Needs an Employee Screening Form?

Employers that carry out background checks before someone starts, particularly where staff handle sensitive information, client data or company vehicles. The candidate completes it after a conditional offer, and HR or the hiring manager uses it to run the checks.

Pairs with the Employee Screening Checklist

The detail you gather here is best tracked with the F-HR18 Employee Screening Checklist - a checklist that records which identity, right-to-work and background checks have actually been completed.