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Kansas State University

Division of Human Resources
Kansas State University
103 Edwards Hall
Manhattan, KS 66506-4801
785-532-6277
785-532-6095 (fax)
8 a.m. - 5 p.m. (CST)
Contact HR

Instructions for Completing the Background Check Form PER-59

Effective 1/2013

  1. The hiring department makes an offer of employment contingent on the final candidate successfully completing the background check.
  2. NOTE: refer to information on page one for residents of New York, Minnesota, Oklahoma and California.
  3. The final candidate (applicant) reads and completes page one of the PER-59.
    • Applicant's Last, First and Middle Name
    • Other Names/Alias
    • Social Security Number
    • Date of Birth (mm/dd/yyyy)
    • Driver's License Number (complete ONLY for those positions previously authorized by HR)
    • State of Driver's License (complete ONLY for those positions previously authorized by HR)
    • Applicant's Present Address
    • Applicant's Telephone #
    • City/State/Country/Zip
    • Email address of applicant
  4. The hiring department completes page two of the PER-59.
    • Hiring Department/Hiring College
    • Position Title
    • Position Number
    • Indicate type of position (Classified, Unclassified, Graduate position) Driver's License Check? (Yes or No) (ONLY if previously authorized by AVP of HR)
    • Primary Department Contact Person
    • Phone Number of primary contact person
    • Email address of primary contact person
    • Secondary Department Contact Person/phone number/ email address (optional)
  5. Print all pages of the PER-59. Applicant signs and dates the form. (Applicant must keep the original and all of the attached documents.)
  6. If the applicant is a resident of California or New York, print the appropriate notice for those states.
  7. The department faxes or sends a copy of the PER-59 form only (not the attachments) to the Background Check Manager (BCM) by Fax to 785-532-6095 or by mail to Division of Human Resources, 103 Edwards Hall, Manhattan, KS 66506. The entire form includes the first two pages.
  8. The BCM requests a background check be performed on the final candidate through Validity Screening Solutions on their secure website.
  9. If the background check is CLEAR on the final candidate, the hiring department will receive an email from the BCM indicating the final candidate is approved for hire and the hiring department may proceed with the hiring process. Hiring department must attach a copy of this email message to the appointment papers submitted to HR. (If the candidate is being considered for an unclassified position, a representative in the Office of Affirmative Action will be copied on this email sent by the BCM.)

Additional Information