Fair Credit Reporting Act Disclosure And Authorization To Release Information - University Of Tennessee
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2FAIR CREDIT REPORTING ACT DISCLOSURE
AND AUTHORIZATION TO RELEASE INFORMATION
DISCLOSURE
In connection with your application for employment at the University of Tennessee, the University may verify
information within the application or other materials relating to your application for employment. As part of that
verification process, the University will request, from a background check vendor, an investigative consumer
report (“Background Check Report”) on you as defined in the Fair Credit Reporting Act.
For University purposes, a Background Check Report will consist of a criminal background check, employment
verification, education verification, reference check, public records check, driving records check, and professional
license check. It will not include a credit check, although information that pertains to your credit may be
contained among public records (i.e., bankruptcy filings). The information obtained in the Background Check
Report will be utilized only during the initial employment application process. In the event that information from
the report is utilized in whole or in part in making an adverse decision, before making the adverse decision, we
will provide to you a copy of the Background Check Report and a description in writing of your rights under the
Fair Credit Reporting Act, 15 U.S.C. § 1681 et seq.
AUTHORIZATION
By my signature below, I expressly authorize and instruct the background check vendor to perform and release to
the University a Background Check Report on me at the request of the University in conjunction with my job
application. I understand that, to the extent allowed by law, information contained in my job application or
otherwise disclosed by me, if any, may be used for the purpose of conducting a background check.
By my signature below, I also authorize the disclosure to the University and/or to the background check vendor of
information concerning my employment history, earning history, education, motor vehicle history and standing,
criminal history, and all other publicly available information the University deems pertinent by any individual,
corporation or other private or public entity, including without limitation the following: employers; learning
institutions, including colleges and universities; law enforcement agencies; federal, state and local courts; the
military; motor vehicle records agencies; and other public sources. I hereby release and hold the background
check vendor and the University, its officers, directors, employees, and trustees harmless from any and all liability
with respect to the Background Check Report, investigations, verifications, and/or the use of any information
relevant to my employment.
By my signature below, I acknowledge that this Authorization Form, in original, faxed, photocopied or electronic
form, will be valid for any reports that may be requested by the University of Tennessee.
Signature of Applicant: _____________________________________________ Date:______________________
Print Full Name: __________________________________________Social Security #: ______-_____-________
Other Names Used (alias, maiden, nickname)_______________________________________________________
Driver’s License Number __________________ State Issued ________ Date of Birth: _____/______/________
Current Residence Address:_____________________________________________________________________
(Number & Street)
City
State
Zip
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