Consent to Request Consumer Report & Investigative Consumer Report Information

Transcription

1 Cnsent t Request Cnsumer Reprt & Investigative Cnsumer Reprt Infrmatin Applicant's First Name r Initial Last Name I understand that [Cmpany Name] ( COMPANY ) will utilize the services f Sterling InfSystems Inc., Inc., 249 West 17th Street, New Yrk, NY 10011, (800) t btain a cnsumer reprt and/r investigative cnsumer reprt as part f the prcedure fr prcessing my applicatin fr emplyment. I als understand that if my applicatin fr emplyment is granted, t the extent permitted by law, COMPANY may btain further infrmatin thrugh subsequent investigatins by STERLING s as t update, renew r extend my emplyment. I understand Sterling InfSystems Inc. ( STERLING ) investigatin may include btaining infrmatin regarding my credit backgrund, bankruptcies, driving recrd, lawsuits, judgments, paid tax liens, unlawful detainer actins, failure t pay spusal r child supprt, accunts placed fr cllectin, and criminal recrd, subject t any limitatins impsed by applicable federal and state law. I understand such infrmatin may be btained thrugh direct r indirect cntact with frmer emplyers, schls, financial institutins, landlrds and public agencies r ther persns wh may have such knwledge. If an investigative cnsumer reprt is being requested, I understand such infrmatin may be btained thrugh any means, including but nt limited t persnal interviews with my acquaintances and/r assciates r with thers whm I am acquainted r wh may have knwledge cncerning my character, general reputatin, persnal characteristics r standard f living. I understand that I have the right t receive ntice abut the nature and scpe f any investigative cnsumer reprt requested within five days after the COMPANY receives my request r five days after the investigative cnsumer reprt was requested, whichever is later. By filling in this circle, I indicate that I wish t receive further disclsure abut the nature and scpe f any COMPANY request fr an investigative cnsumer reprt. I acknwledge that I have received the attached summary f my rights under the Fair Credit Reprting Act and, as required by law, any related state summary f rights. This cnsent will nt affect my ability t questin r dispute the accuracy f any infrmatin cntained in my reprt. I understand if COMPANY makes a cnditinal decisin t disqualify me based all r in part n my reprt, I will be prvided with a cpy f the reprt and anther descriptin in writing f my rights under the federal Fair Credit Reprting Act and, as required by law, any related state summary f rights, and if I disagree with the accuracy f the purprted disqualifying infrmatin in the reprt, I must ntify COMPANY within five business days f my receipt f the reprt that I am challenging the accuracy f such infrmatin with Sterling InfSystems Inc. I hereby cnsent t this investigatin and authrize COMPANY t prcure a cnsumer reprt(s) and/r investigative cnsumer reprt n my backgrund as stated abve frm a cnsumer reprting agency and/r investigative cnsumer reprting agency. In rder t verify my identity fr the purpses f backgrund identificatin, I am vluntarily releasing my date f birth, scial security number and the ther infrmatin belw fr my wn benefit and fully understand that all emplyment decisins are based n legitimate nn-discriminatry reasns. Minnesta & Oklahma Applicants Only: I have the right t request a cpy f the cnsumer reprt btained by COMPANY frm STERLING by checking the bx. STERLING will mail the cnsumer reprt directly t me. I wish t receive a cpy f the cnsumer/investigative cnsumer reprt. (Check nly if yu wish t receive a cpy.) Maine Applicants Only: By checking the bx, I indicate that I wish t receive the name, address and telephne number f the nearest unit f the cnsumer reprting agency designated t handle inquiries regarding the investigative cnsumer reprt. Washingtn State Applicants Only (AS APPLICABLE): I further understand that COMPANY will nt btain infrmatin abut my credit wrthiness, credit standing, r credit capacity unless the infrmatin is required by law, r is substantially jb related, and the reasns fr using the infrmatin are disclsed t me in writing. (If this ptin is checked, cmplete the questin belw.) Reasns why COMPANY cnsiders infrmatin abut credit wrthiness, credit standing, r credit capacity as substantially jb related: NY Applicants Only: I als acknwledge that I have received the attached cpy f Article 23A f New Yrk s Crrectin Law. I further understand that I may review and receive a cpy f any investigative cnsumer reprt by cntacting the cnsumer reprting agency. I further understand that I will be advised if any further checks are requested and prvided the name and address f the cnsumer reprting agency. Signature: Tday s Date: USCACDEN-V02 Page 1 f 5

2 Fr Office Use Only Grup ID (ptinal) Fr Office Use Only User ID (ptinal) Fr Office Use Only Lcatin / Stre # (ptinal) First Name Middle Name r Initial Last Name Date f Birth (MMDDYYYY) Other Names Knwn By Male Female Scial Security Number Primary Telephne Number (n dashes) Current Address Apt # #yrs at this address City State Zip Cde Previus Address Apt # #yrs at this address City State Zip Cde Driver s License Number (n dashes) License State Address Signature Tday s Date (MMDDYYYY) USCACDEN-V02 Page 2 f 5

3 Para infrmacin en espanl, visite escribe a la FTC Cnsumer Respnse Center, Rm 130-A 600 Pennsylvania Ave. N.W., Washingtn, D.C A Summary f Yur Rights Under the Fair Credit Reprting Act The federal Fair Credit Reprting Act (FCRA) prmtes the accuracy, fairness, and privacy f infrmatin in the files f cnsumer reprting agencies. There are many types f cnsumer reprting agencies, including credit bureaus and specialty agencies (such as agencies that sell infrmatin abut check writing histries, medical recrds, and rental histry recrds). Here is a summary f yur majr rights under the FCRA. Fr mre infrmatin, including infrmatin abut additinal rights, g t r write t: Cnsumer Respnse Center, Rm 130-A, Federal Trade Cmmissin, 600 Pennsylvania Ave. N.W., Washingtn, D.C Yu must be tld if infrmatin in yur file has been used against yu. Anyne wh uses a credit reprt r anther type f cnsumer reprt t deny yur applicatin fr credit, insurance, r emplyment r t take anther adverse actin against yu must tell yu, and must give yu the name, address, and phne number f the agency that prvided the infrmatin. Yu have the right t knw what is in yur file. Yu may request and btain all the infrmatin abut yu in the files f a cnsumer reprting agency (yur file disclsure ). Yu will be required t prvide prper identificatin, which may include yur Scial Security number. In many cases, the disclsure will be free. Yu are entitled t a free file disclsure if: a persn has taken adverse actin against yu because f infrmatin in yur credit reprt; yu are the victim f identify theft and place a fraud alert in yur file; yur file cntains inaccurate infrmatin as a result f fraud; yu are n public assistance; yu are unemplyed but expect t apply fr emplyment within 60 days. In additin, by September 2005 all cnsumers will be entitled t ne free disclsure every 12 mnths upn request frm each natinwide credit bureau and frm natinwide specialty cnsumer reprting agencies. See fr additinal infrmatin. Yu have the right t ask fr a credit scre. Credit scres are numerical summaries f yur credit-wrthiness based n infrmatin frm credit bureaus. Yu may request a credit scre frm cnsumer reprting agencies that create scres r distribute scres used in residential real prperty lans, but yu will have t pay fr it. In sme mrtgage transactins, yu will receive credit scre infrmatin fr free frm the mrtgage lender. Yu have the right t dispute incmplete r inaccurate infrmatin. If yu identify infrmatin in yur file that is incmplete r inaccurate, and reprt it t the cnsumer reprting agency, the agency must investigate unless yur dispute is frivlus. See an explanatin f dispute prcedures. Cnsumer reprting agencies must crrect r delete inaccurate, incmplete, r unverifiable infrmatin. Inaccurate, incmplete r unverifiable infrmatin must be remved r crrected, usually within 30 days. Hwever, a cnsumer reprting agency may cntinue t reprt infrmatin it has verified as accurate. Cnsumer reprting agencies may nt reprt utdated negative infrmatin. In mst cases, a cnsumer reprting agency may nt reprt negative infrmatin that is mre than seven years ld, r bankruptcies that are mre than 10 years ld. Access t yur file is limited. A cnsumer reprting agency may prvide infrmatin abut yu nly t peple with a valid need -- usually t cnsider an applicatin with a creditr, insurer, emplyer, landlrd, r ther business. The FCRA specifies thse with a valid need fr access. Yu must give yur cnsent fr reprts t be prvided t emplyers. A cnsumer-reprting agency may nt give ut infrmatin abut yu t yur emplyer, r a ptential emplyer, withut yur written cnsent given t the emplyer. Written cnsent generally is nt required in the trucking industry. Fr mre infrmatin, g t USCACDEN-V02 Page 3 f 5

4 Yu may limit prescreened ffers f credit and insurance yu get based n infrmatin in yur credit reprt. Unslicited prescreened ffers fr credit and insurance must include a tll-free phne number yu can call if yu chse t remve yur name and address frm the lists these ffers are based n. Yu may pt-ut with the natinwide credit bureaus at OPTOUT ( ). Yu may seek damages frm vilatrs. If a cnsumer reprting agency, r, in sme cases, a user f cnsumer reprts r a furnisher f infrmatin t a cnsumer reprting agency vilates the FCRA, yu may be able t sue in state r federal curt. Identity theft victims and active duty military persnnel have additinal rights. Fr mre infrmatin, visit States may enfrce the FCRA, and many states have their wn cnsumer reprting laws. In sme cases, yu may have mre rights under state law. Fr mre infrmatin, cntact yur state r lcal cnsumer prtectin agency r yur state Attrney General. Federal enfrcers are: FOR QUESTIONS OR CONCERNS REGARDING Cnsumer reprting agencies, creditrs and thers nt listed belw Natinal banks, federal branches/agencies f freign banks (wrd "Natinal" r initials "N.A." appear in r after bank's name) Federal Reserve System member banks (except natinal banks, and federal branches/agencies f freign banks) Savings assciatins and federally chartered savings banks (wrd "Federal" r initials "F.S.B." appear in federal institutin's name) Federal credit unins (wrds "Federal Credit Unin" appear in institutin's name) State-chartered banks that are nt members f the Federal Reserve System Air, surface, r rail cmmn carriers regulated by frmer Civil Aernautics Bard r Interstate Cmmerce Cmmissin Activities subject t the Packers and Stckyards Act, 1921 PLEASE CONTACT Federal Trade Cmmissin Cnsumer Respnse Center- FCRA Washingtn, DC Office f the Cmptrller f the Currency Cmpliance Management, Mail Stp 6-6 Washingtn, DC Federal Reserve Bard Divisin f Cnsumer & Cmmunity Affairs Washingtn, DC Office f Thrift Supervisin Cnsumer Prgrams Washingtn D.C Natinal Credit Unin Administratin 1775 Duke Street Alexandria, VA Federal Depsit Insurance Crpratin Divisin f Cmpliance & Cnsumer Affairs Washingtn, DC Department f Transprtatin Office f Financial Management Washingtn, DC Department f Agriculture Office f Deputy Administratr-GIPSA Washingtn, DC USCACDEN-V02 Page 4 f 5

5 H:\GREENBER\Sterling\2008 Cnsent Frms\Cnsent Disclsure All But Califrnia - final draft.dc USCACDEN-V02 Page 5 f 5