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Employment Background Check Release

Client Company Disclosure Of Intent To Obtain Consumer Reports Or Investigative Consumer Reports

Click Below for a copy of the release form and a summary of rights:


https://secure.premium-background-checks.com/CompliancyPDF/Authorization_DisclosureAff.pdf

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Updated 12/01/2016
For employment purposes, a consumer reporting agency may obtain consumer reports, or investigative consumer reports, in connection with your employment application or from time to time during employment in accordance with applicable law. Consumer reports include record checks conducted by consumer reporting agencies and may include driving records, criminal records, credit records, etc. Investigative consumer reports include investigations (for example, reference checks) conducted by consumer reporting agencies through personal interviews (or through any means in California) on information as to character, general reputation, personal characteristics, or mode of living. You may make a written request for a summary of consumer rights and a disclosure of the nature and scope of an investigation. A disclosure of the nature and scope of such investigation is provided below.

DISCLOSURE OF NATURE AND SCOPE OF INVESTIGATION FOR INVESTIGATIVE CONSUMER REPORTIn the event we request an investigative consumer report in connection with your employment application, a consumer reporting agency will prepare an investigative consumer report based on the following investigation: The agency will interview your former employers, business references, and/or personal references for information regarding prior employment, work experience and performance, reasons for employment termination, and information as to character, general reputation, personal characteristics, or mode of living. The agency will also conduct a records check of driving, criminal, credit, education,worker’s compensation claim history,degrees, professional licenses, and/ or certification records depending on the position. Such a report, as well as any credit report, will be obtained from a consumer reporting agency.I have received a summary of my rights under the Fair Credit Reporting Act.AUTHORIZATION
I authorize ________________________________________a consumer reporting agency to obtain consumer reports and/or investigative consumer reports regarding me from time to time for employment purposes. In compliance with the Fair Credit Reporting Act, as amended by the Consumer Credit Reporting Reform Act of 2003, a consumer reporting agency needs my authorization to obtain such a report.
_____________________________________, CERTIFY THAT I HAVE RECEIVED A COPY OF “A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT”
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This information will not be used for the purpose of discrimination. The Federal Age Discrimination in Employ. Act of 1967 prohibits discrimination on the basis of age.
Signature:
Date:
Print Name:
Date of Birth:
Address:
Social Security #:
CityState& ZipDrivers License Number & State (if applicable):
California Applicants OnlyIn California, if you wish to receive a free copy of any credit report obtained, please indicate by checking this box.A summary of the provisions of California Civil Code Section 1786.22 is provided here with.Minnesota Applicants Only If you are in Minnesota and you desire a free copy of your consumer report,please place an “X” in the box.New York Applicants Only Upon your request, you will be informed whether or not a consumer report was requested, and if such a report was requested, the name and address of the consumer reporting agency furnishing the report.Para informacion en espanol, visite 
www.consumerfinance.gov/ describe a la Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20006. A Summary of Your Rights Under the Fair Credit Reporting ActThe federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records).Here is a summary of your major rights under the FCRA.For more information, including information about additional rights, go to www.consumerfinance.gov/or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20006.You may have additional rights under Maine’s FCRA, Me. Rev. Stat. Ann. 10, Sec 1311 et seq.You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment or to take another adverse action against you must tell you, and must give you the name, address, and phone number of the agency that provided the information.You have the right to know what is in your file.You may request and obtain all the information about you in the files of a consumer reporting agency (your “file disclosure”). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if a person has taken adverse action against you because of information in your credit report; you are the victim of identity theft and place a fraud alert in your file; your file contains inaccurate information as a result of fraud; you are on public assistance; you are unemployed but expect to apply for employment within 60 days. In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.consumerfinance.gov/ learn more for additional information.You have the right to ask for a credit score.Credit scores are numerical summaries of your credit worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender.You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. Seewww.consumerfinance.gov/ for an explanation of dispute procedures.Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information.Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate.Consumer reporting agencies may not report outdated negative information.In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old.Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need–usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access.You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry.
For more information, go to 
http://www.consumerfinance.gov/ 
You may limit “pre-screened” offers of credit and insurance you get based on information in your credit report. Unsolicited “pre-screened” offers for credit and insurance must include a toll free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt out with the nationwide credit bureaus at 1 888 567 8688.

 
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