Instructions for Completing the
Background Check Form PER-59
- The hiring department makes an offer of employment contingent
on the final candidate successfully completing the background check.
- NOTE: refer to information on page one for residents of New
Minnesota, Oklahoma and California.
- The final candidate (applicant) reads and completes page one of the
- 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
authorized by HR)
- State of Driver's License (complete ONLY for those
authorized by HR)
- Applicant's Present Address
- Applicant's Telephone #
- Email address of applicant
- 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
Driver's License Check? (Yes or No) (ONLY if previously
authorized by AVP
- Primary Department Contact Person
- Phone Number of primary contact person
- Email address of primary contact person
- Secondary Department Contact Person/phone number/ email address
- Print all pages of the PER-59. Applicant signs and dates the
(Applicant must keep the original and all of the attached
- If the applicant is a resident of California or New York,
appropriate notice for those states.
- 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.
- The BCM requests a background check be performed on the final
through Validity Screening Solutions on their secure website.
- 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
message to the appointment papers submitted to HR. (If the
being considered for an unclassified position, a representative in the
Office of Affirmative Action will be copied on this email sent by the