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Form Doj555 - Disclosure And Authorization Pertaining To Consumer Reports Pursuant To The Fair Credit Reporting Act

United States Department of Justice

Disclosure and Authorization

Pertaining to Consumer Reports

Pursuant to the Fair Credit Reporting Act

(Title 15, U.S. Code, Section 1681)

This is a release for the Department of Justice to obtain one or more consumer/credit reports

about you in connection with your application for Federal employment, during the course of your

Federal employment (including employment under contract), and/or in connection with your

security clearance or your access to classified information. One or more reports about you may

be obtained for purposes of evaluating your fitness for employment, promotion, reassignment,

retention, access to classified information, or other employment purposes.

I, ____________________________________________, hereby authorize the Department of

Justice to obtain, and I further instruct any consumer/credit reporting agency to release to DOJ,

any such report(s) for the above purposes.

______________________________

Signature

______________________________

Date

______________________________

Social Security Number

______________________________

Current Organization Assigned

DOJ-555

Revised Dec. 2004

Security and Emergency Planning Staff

Form Doj555 - Disclosure And Authorization Pertaining To Consumer Reports Pursuant To The Fair Credit Reporting Act