Authorization Form For Consumer Reports

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SAMPLE AUTHORIZATION
As the employer or user of consumer reports, it is your responsibility to ensure
compliance with all of the relevant federal, state and local laws governing this area. We strongly recommend that prior to
use, you consult with an attorney.
AUTHORIZATION FORM FOR CONSUMER REPORTS
In connection with your application for employment (including contract for services), understand that consumer reports or
investigative consumer reports which may contain public record information may be requested or made on you including
consumer credit, criminal records, driving record, education, prior employer verification, workers compensation claims
and others. These reports will include experience information along with reasons for termination of past employment.
Further, understand that information from various Federal, State, local and other agencies which contain your past
activities will be requested. A consumer report containing injury and illness records and medical information may be
obtained only after a tentative offer of employment has been made.
By signing below, you hereby authorize without reservation, any party or agency contacted by this employer to furnish the
above mentioned information. You further authorize ongoing procurement of the above mentioned reports at any time
during your employment (or contract).
You also agree that a fax or photocopy of this authorization with your signature be accepted with the same authority as the
original.
You have the right to make a request of First Advantage, upon proper identification and the payment of any legally
permissible fees, for the information in its files on you at the time of your request.
You hereby authorize and request, without any reservation, any present or former employer, school, police department,
financial institution, division of motor vehicles, consumer reporting agencies, or other persons or agencies having
knowledge about you to furnish First Advantage with any and all background information in their possession regarding
you, in order that your employment qualifications may be evaluated.
For California, Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one
is obtained, please check this box.
If checked and you are a California applicant, a copy of the consumer report will be
sent within three (3) days of the employer receiving a copy of the consumer report.
For California applicants only, if public record information about your character, general reputation, personal
characteristics, and mode of living is obtained without using a consumer reporting agency, you will be supplied a copy of
the public record information within seven (7) days of the employer’s receipt unless you check this box where you hereby
waive your right to obtain a copy of the consumer report.
Print your Name: ______________________________________________________
Street Address: ________________________________________________________
City: ______________________________ State: ___________ Zip: _____________
Social Security Number: ________________________________________________
Driver’s License State: _________ License Number: _________________________
The following is for identification purposes only to perform the background check:
Date of Birth (MM/DD/YYYY): ____________ Race: ____ Gender (M or F): _____
Other or Former Names: _________________________________________________
Professional License: ______ State: _______ Type: _______ Number: ____________
Signature: ____________________________________ Date: _____________________

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