Combined Disclosure Notice And Authorization Consumer Reports Form printable pdf download

SAMPLE COMBINED DISCLOSURE AND AUTHORIZATION:

As the employer or end-

user of consumer reports, it is your responsibility to ensure compliance with all of the relevant federal,

state and local laws governing this area. [If you are located in California or obtain consumer reports on

California residents, please refer to

also you may request a copy of our Sample

CA Disclosure and Authorization

Form]. We strongly recommend that prior to use, you consult with an

attorney.

COMBINED DISCLOSURE NOTICE AND AUTHORIZATION REGARDING

BACKGROUND CONSUMER REPORTS

Important: Please read carefully before signing.

DISCLOSURE

A consumer report and/or investigative consumer report including information concerning your

character, employment history, general reputation, personal characteristics, police record,

criminal records, education, qualifications, motor vehicle record, mode of living and/or credit

and indebtedness may be obtained in connection with your application for and/or continued

employment with the employer. A consumer report and/or an investigative consumer report

may be obtained at any time during the application process or during your employment

with the company.

These reports may include experience information along with reasons for

termination of past employment. Further, understand that information from various Federal, State, local

. A consumer report containing

and other agencies which contain your past activities may be requested

injury and illness records and medical information may be obtained after a tentative offer of

employment has been made.

The name, address and telephone number of the Company preparing the report is: First

Advantage P.O. Box 3367 Seminole, FL 33775-3367; Toll free number: 1-800-321-4473 ext. 8.

Their privacy Policy can be reviewed at

Before any adverse action is taken, based in whole or in part on the information contained in the

consumer report, you will be provided a copy of the report, the name, address and telephone

number of the reporting agency, and a summary of your rights under the Fair Credit Reporting

Act.

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 wave your right to

obtain a copy of the investigative consumer report .

Please be advised that you have a right to inspect the files that the Consumer Reporting Agency may have

on you during normal business hours and upon you furnishing proper identification.

Combined Disclosure Notice And Authorization Consumer Reports Form

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