Fair Credit Reporting Act Disclosure And Consent Form - Progressive Savings Bank And The Rains Agency, Inc.

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FAIR CREDIT REPORTING ACT DISCLOSURE AND CONSENT FORM
15 U.S.C. § 1681b(b)(2)
I, _________________________, certify that Progressive Savings Bank and The
Rains Agency, Inc. disclosed to me that it may obtain a consumer report prepared by a
consumer reporting agency for the purpose of evaluating me for employment, promotion,
reassignment, or retention as an employee.
I understand that a consumer report may include, but is not limited to, information
bearing on credit worthiness, credit standing, credit capacity, criminal background,
character, general reputation, personal characteristics, and/or mode of living.
I, _________________________, state that I have read and understood this
disclosure and hereby authorize Progressive Savings Bank and The Rains Agency, Inc. to
procure a consumer report. I further understand that my social security number and date
of birth are being requested below solely for the purpose of generating an accurate
consumer report.
________________________
Name
________________________
Date
________________________
Social Security Number  
K TBM 223042 vl
0-0 2/16/2009
 

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