Sample Disclosure/
Authorization
Fair Credit Reporting Act
Disclosure & Authorization Regarding Procurement Of An Investigative
Consumer Report
In connection with your application for employment or when deciding
whether to modify or continue your employment (if you are hired),
we may obtain and use an "investigative consumer report"
about you from a "consumer reporting agency." A "consumer
reporting agency" is a person or business which, for monetary
fees, dues, or on a cooperative nonprofit basis, regularly assembles
or evaluates consumer credit information or other information on
consumers for the purpose of furnishing "investigative consumer
reports" to third parties.
This report may include information as to your character, general
reputation, personal characteristics and mode of living. This information
may be obtained by contacting your previous employers and/or references
supplied by you or others.
In the event that information from the report is utilized in whole
or in part in making an adverse decision with regard to your employment,
before making the adverse decision, we will provide you with a copy
of the investigative consumer report and a description in writing
of your rights under the law.
Please be advised that you have the right to request, in writing,
within a reasonable time, that we make a complete and accurate disclosure
of the nature and scope of the information requested. Such disclosure
will be made to you within 5 days of the date on which we receive
the request from you or within 5 days of the time the report was
first requested.
The Fair Credit Reporting Act gives you specific rights in dealing
with consumer reporting agencies. You will be given a summary of
these rights together with this document.
By your signature below, you hereby authorize us to obtain a consumer
investigative report about you.
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