Background Check Disclosure And Authorization Form - Vancouver Human Resources printable pdf download

BACKGROUND CHECK DISCLOSURE AND AUTHORIZATION FORM

In the interest of maintaining the safety and security of our customers, employees and property, the City of Vancouver (the

“City”) will order a “consumer report” (a background report) or “investigative consumer report" on you in connection with your

employment application, and if you are hired, or if you already work for the City, may order additional background reports on

you for employment purposes.

The background check City, ADP Screening and Selection Services, will prepare the background report for the City. ADP

Screening and Selection Services is located at 301 Remington Street, Fort Collins, CO, 80524, and can be reached by

phone at 800-367-5933 or at their Internet Web site address

The background report may contain information concerning your character, general reputation, personal characteristics,

mode of living, and credit standing. The types of information that may be ordered include but are not limited to: Social

Security number verification; criminal, public, educational and, as appropriate, driving records checks; verification of prior

employment; reference, licensing and certification checks; credit reports; drug testing results; and, if applicable, worker’s

compensation injuries. Workers’ compensation information will only be requested in compliance with federal Americans with

Disabilities Act and/or any other applicable federal, state or local laws and only after a conditional job offer is made. Credit

history will only be requested when permitted by law and where such information is substantially related to the duties and

responsibilities of the position for which you are applying*. The information may be obtained from private and public record

sources, including personal interviews with your associates, friends, and neighbors. (An “investigative consumer report” is a

background report that includes information from such personal interviews, except in California where that term means any

background report that is not a credit report.) The nature and scope of the most common form of investigative consumer

report is an investigation into your education and/or employment history conducted by ADP Screening and Selection

Services or another outside organization.

You may request more information about the nature and scope of an investigative consumer report, if any, by telephoning

the City at 360-487-8406. A summary of your rights under the Fair Credit Reporting Act is also being provided to you with

this form.

The Fair Credit Reporting Act gives you specific rights in dealing with consumer reporting agencies. You will find these rights

summarized on A Summary of Your Rights Under the Fair Credit Reporting Act and A Summary of Your Rights Under the

Provisions of California Civil Code Section 1786.22 as provided here.

*The City of Vancouver will not request ADP to perform credit or financial check information for volunteers unless

the volunteer will be in contact with or handling financial transactions.

STATE LAW NOTICES

If you live or work for the City in the states listed below, please note the following:

OREGON: If the City obtains credit history information on you, it will be used to evaluate whether you would present an

unacceptable risk of theft or other dishonest behavior in the job for which you are being considered.

WASHINGTON STATE: If you submit a request to us in writing, you have the right to get from the City a complete and

accurate disclosure of the nature and scope of the investigative consumer report we ordered, if any. You also have the right

to ask ADP Screening and Selection Services for a written summary of your rights under the Washington Fair Credit

Reporting Act. If the City obtains information bearing on your credit worthiness, credit standing or credit capacity, it will be

used to evaluate whether you would present an unacceptable risk of theft or other dishonest behavior in the job for which

you are being considered.

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Background Check Disclosure And Authorization Form - Vancouver Human Resources