Complete this section for Hallock Technologies’ direct checks. Fields marked * are required. Your SSN, birth date, license details, and other answers in this section are encrypted when saved and excluded from routine application emails and emailed application PDFs. Access is restricted to authorized screening reviewers.
Legal first name *
Full middle name, if any
Legal last name *
Suffix, if any
Other names used Include maiden, former legal, employment, or school names; enter None if applicable.
Social Security number *
Date of birth *
Enter nine digits, with or without hyphens. These identifiers help match the correct records. If you need assistance, contact Hallock Technologies without sending your SSN by email.
Current physical street address *
City *
State, province, or region *
ZIP or postal code *
Prior addresses relevant to your records (optional) Include dates if a prior address helps locate employment, education, or licensing records. A fixed seven-year address history is not requested.
Do you hold a driver’s license? * Select an answer Yes No Driving records are checked only when driving is relevant to the position.
License issuing state, province, or country
Driver’s license number
Name on license, if different
If you hold a license, provide its number and issuing jurisdiction. Before Hallock requests a Pennsylvania driving record, you must complete the applicable PennDOT driver release. This application does not replace the agency’s form.
Sex shown in official records (optional)
Race identifier for PSP records (optional)
The Pennsylvania State Police request form includes sex and race identifiers for matching records. These optional answers are confidential, are not used to evaluate qualifications, and may be requested separately if needed by the agency.
Education verification details (if applicable) For each school or training provider listed above, provide its city/state, dates attended, award date if applicable, and registrar contact or website. Include the name used on the record. Do not enter student IDs, passwords, or transcript files.
Employment verification notes (optional) Identify a different name on employer records or an HR verification contact. Your employer-contact preferences in the application will be honored.
I authorize Hallock Technologies to conduct the Pennsylvania criminal-history check and verify the employment and education information I provided, at the legally permitted stage of hiring. My employer-contact preferences must be honored. I understand that any required driving-record release or consumer-report disclosure and authorization will be obtained separately. I certify that these screening details are accurate to the best of my knowledge.
Type your full name to sign this authorization *
By typing your name and submitting the application, you agree to use your typed name as your electronic signature for this authorization. The submission date and time will be recorded.