IC Background Check Request

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IC Background Check Request

This form is used to determine if a background check is required prior to an independent contractor’s contracted service. Based on the answers to the following questions, the Human Resources Office will determine whether a background check is required. If this is required, HR will send a background check invite from the vendor, Atlantic Employee Screening, to the independent contractor's email provided on the form.

Once the results are received, HR will communicate with the form initiator and the Finance Office regarding the approval status. The IC should not work until the background check approval is confirmed. If a background check is not needed, the Finance Office will move forward with processing the IC on their end.

Providing complete information on this form will allow efficient and effective resolution to this step of the Independent Contractor Checklist process.

Requestor Name

Requesting Department

Contractor First Name

Contractor Last Name

Contractor Email Address

Background Check Criteria:

Person will work directly with Stetson student(s) without a Stetson faculty member or staff member present. This includes work completed in a remote environment.

Person will have direct contact (including virtual) working with minors under the age of 18 who are not current Stetson students.

Person will be working at a youth camp (any attendees under 18) at any location.

Person will serve as an art model that includes nude or seminude modeling?

Date of last background check (if known):

Please explain in a few sentences, what work will contractor complete/be responsible for?

What date(s) will the contractor be completing work at Stetson?

Please specify a date range, if known; otherwise, please enter the specific semester(s) or academic year(s) that apply.

FOAP the background check should be charged to:

Additional Comments

You will receive a copy of this form in your e-mail. If all of your above answers to the criteria are “no”, the form will go directly to the Finance Office. If you answered “yes” or “maybe”, the Human Resources department will review the need for the background check and initiate the check as applicable. Each background check will be reviewed and assessed on a case by case basis by the HR department.

Payment for Background Checks:

If a background check is required, HR will notify the Finance office to transfer the appropriate funds from the FOAP listed above. The cost for each domestic background check is $30. The cost may be more in the event an international background check is required.

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