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Certification Verification · Pro

Professional License & Certification Verification Form

Streamline credential checks with a form that captures requestor info, license details, issuing authority, and supporting documentation in one place.

Use This Template Free Preview

Umber theme

formbuilder.ai/f/professional-license-certification-verification-request-form

Professional License & Certification Verification Request Form

Your Full Name

· · ·

Your Email Address

· · ·

Phone Number

· · ·

Submit

The Professional License & Certification Verification Request Form is designed to help organizations systematically confirm the validity of professional credentials held by employees, contractors, vendors, or applicants. It collects all essential information — from the requestor's identity and purpose to the license holder's details, certification number, issuing authority, and current status — ensuring nothing is overlooked during the verification process.

This template is ideal for HR departments, healthcare organizations, legal firms, staffing agencies, and compliance teams that need a reliable, audit-ready way to document credential checks. Whether you're onboarding new hires, renewing vendor contracts, or meeting regulatory requirements, this form provides a clear and consistent process for every verification request.

With fields for uploading supporting documentation such as copies of licenses and authorization letters, the form creates a complete digital record that simplifies compliance reporting and reduces administrative back-and-forth. Customize it to fit your industry's specific licensing requirements and start verifying credentials with confidence today.

3 Pages

22 Questions

~7min To complete

Free Included on every plan

Field types Short Text ×5 Dropdown ×3 Full Name ×2 Email ×2 Date ×2 Phone Single Choice Long Text daterange File Upload singlecheckbox termsandconditions Signature

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Requestor Information 8 questions

Requestor Information

1 Your Full Name * Full Name

2 Your Email Address * Email

3 Phone Number * Phone

4 Company / Organization Name * Short Text

5 Your Role * Dropdown

6 Department Short Text

7 Reason for Verification Request * Single Choice

8 Additional Details on Verification Purpose Long Text

Page 2 License & Certification Details 10 questions

License & Certification Details to Verify

1 Full Name of License / Certification Holder * Full Name

2 License Holder's Email Address (if known) Email

3 License Holder's Date of Birth Date

4 License / Certification Number * Short Text

5 Issuing Authority or Certifying Body * Short Text

6 License / Certification Type * Dropdown

7 Specialty or Discipline (if applicable) Short Text

8 License / Certification Validity Period * daterange

9 Current Status (if known) Dropdown

10 Upload Supporting Documentation (e.g., copy of license, authorization letter) File Upload

Page 3 Authorization & Submission 4 questions

Authorization & Consent

By submitting this form, you confirm that this verification request is made for a lawful purpose and that you are authorized to request this information on behalf of your organization. Any information obtained will be used solely for the stated verification purpose.

1 I confirm that I am authorized to submit this verification request on behalf of my organization. * singlecheckbox

2 I agree to the Terms of Use and Privacy Policy governing the handling of personal and professional credential data. * termsandconditions

3 Requestor Signature * Signature

4 Date of Request * Date

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.