Fillable Background Check Authorization Form - Camp Danbee printable pdf download

DISCLOSURE OF BACKGROUND CHECK TO BE CONDUCTED ON YOU

In connection with your application and/or employment with CAMPGROUP LLC (“Employer”) this notice is provided to inform you that a “consumer report”

and/or “investigative consumer report”, as defined by the Fair Credit Reporting Act, may be obtained from a consumer reporting agency for employment

purposes. These types of reports may include information as to your character, general reputation, personal characteristics and mode of living, whichever

are applicable. The report(s) may also contain information about you relating to your criminal history, credit history, driving and/or motor vehicle records,

verification of your education or employment history and other background checks. They may involve interviews with sources such as your neighbors, friends

or associates.

ACKNOWLEDGMENT AND AUTHORIZATION OF BACKGROUND CHECK

By signing below, I authorize CAMPGROUP LLC (“Employer”) to obtain “consumer reports” and/or “investigative consumer reports” about me during the

course of the application process and during the course of my employment, to the extent permitted by law. You have the right, upon written request made

within a reasonable amount time after the receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report by

contacting 17295 Foltz Industrial Parkway, Suite B, Strongsville, OH 44149 [1-877-992-4325].

Minnesota applicants or employees only: You have the right, upon written request to , to receive a complete and accurate disclosure of

the nature and scope of any consumer report. must make this disclosure within five days of receipt of your request or of Employer’s request

for the report, whichever is later. Please check this box if you would like to receive a copy of a consumer report if one is obtained by Employer. !

Massachusetts and New Jersey applicants or employees only: You have the right to inspect and promptly receive a copy of any investigative consumer

report requested by Employer by contacting the consumer reporting agency, , directly.

New York applicants or employees only: You have the right, upon request, to be informed of whether or not a consumer report was requested from a

consumer reporting agency by contacting the consumer reporting agency, Crimcheck. If a consumer report is requested, you will again be provided with the

name and address of the consumer reporting agency furnishing the report. You may inspect and receive a copy of the report by contacting Crimcheck. By

signing, you acknowledge receipt of Article 23-A of the New York Correction Law.

Washington State applicants or employees only: You have the right to receive a complete and accurate disclosure of the nature and scope of any

investigative consumer report as well as a written summary of your rights and remedies under Washington law.

California applicants or employees only:

By signing below, you also acknowledge receipt of the NOTICE REGARDING BACKGROUND

INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check this box if you would like to receive a copy of an investigative consumer report at no

charge if one is obtained by the Company whenever you have a right to receive such a copy under California law. !

Signature: _____________________________________________________________ Date: _________________

Name: _________________________________________________________________________________________

Personal Information Necessary To Facilitate Background Check

Please provide the following information in order to facilitate a background check on you.

Name: ______________________________________________________________________________________________________________________

First Name

Middle Name (Required if applicable)

Last Name

Please provide any previous names/maiden names or nicknames that have ever been associated with your name:

____________________________________________________________________________________________________________________________

Current Home Address:_________________________________________________________________________________________________________

Street Address (No P.O. Boxes)

City

State

Zip

County

Previous Address:______________________________________________________________________________________________________________

Street Address (No P.O. Boxes)

City

State

Zip

County

How long have you lived at current address? _______________________________

**Date of Birth: _____ / _____ /___________ Driver’s License Number: __________________________________ Driver’s License State: _________

SSN_____________- __________________- _______________

Email Address: ____________________________________________________________________________

** will only use this information for background screening purposes and no other purpose.

Background Check Authorization Form - Camp Danbee

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