National Background Check Permission Forms

Transcription

1 Natinal Backgrund Check Permissin Frms Purpse: Frm t btain a backgrund web search fr an emplyee/vlunteer wh has resided utside the state f Indiana in the previus ten years. 1. Emplyee/vlunteer must cmplete first tw pages and have them witnessed. a. Disclsure f Right t Obtain Cnsumer Reprt b. Disclsure f Rights and Authrizatin 2. Emplyee/vlunteer is t keep last tw pages fr infrmatin. a. A Summary f yur Rights Under the Fair Credit Reprting Act 3. The first tw pages are sent by e mail, fax r US mail t the Safe Envirnment Prgram using: ccicchiell@dicesefwsb.rg; mgibsn@dicesefwsb.rg FAX: Safe Envirnment Crdinatr PO Bx 390 Frt Wayne, IN Attn: First Advantage 4. Results f search are e mailed t the parish/schl. 5. A fee is charged fr this search. 6. A full cpy f this frm in Spanish is available n the dicesan website at the Safe Envirnment page.

2 DISCLOSURE OF RIGHT TO OBTAIN CONSUMER REPORT If authrized by yu, the Dicese f Frt Wayne Suth Bend, Inc. ( Dicese ) may btain and use a cnsumer reprt frm a cnsumer reprting agency that disclses varius infrmatin abut yu. A cnsumer reprt is any written, ral r ther cmmunicatin f any infrmatin by a cnsumer reprting agency that is related t yur criminal histry, credit wrthiness, credit standing, credit capacity, character, general reputatin, persnal characteristics, r mde f living. This infrmatin is cllected and may be used fr the purpse f evaluating yur eligibility fr emplyment r vlunteer service. Unless yu are tld therwise, the target f the cnsumer reprt secured by the Dicese will cncern nly criminal histry infrmatin. A cnsumer reprting agency ( CRA ) is a persn r business that regularly cllects r evaluates cnsumer credit infrmatin r ther infrmatin n cnsumers t prvide cnsumer reprts t thers. The agency perfrms this service fr mnetary fees, dues r n a cperative nn prfit basis. The Fair Credit Reprting Act ( FCRA ) is a federal law that establishes rights fr cnsumers. The FCRA defines cnsumer reprt and a CRA. As an applicant fr emplyment r vlunteer service with the Dicese, yu are a cnsumer and are prtected by the FCRA. If authrized by yu, the Dicese may btain and use a cnsumer reprt frm a CRA when: Cnsidering yur applicatin fr emplyment r vlunteer service; Making a decisin whether t ffer yu emplyment r a vlunteer psitin; Deciding whether t cntinue yur emplyment r vlunteer service (if yu are a current emplyee f vlunteer); and/r Making ther psitin related decisins affecting yu, including jb assignments. Dicese will btain any cnsumer reprts (criminal histries) frm: First Advantage 1000 Alderman Drive Alpharetta, Gergia Telephne: (866) If Dicese btains a cnsumer reprt abut yu, and if Dicese cnsiders any infrmatin in the cnsumer reprt when making a decisin that directly and adversely affects yu, Dicese will disclse this t yu and prvide the name and address and telephne number f the CRA t yu. Included with this Disclsure is a written summary f yur rights as a cnsumer under the FCRA. Please read it carefully and familiarize yurself with yur rights. Yu als may cntact the Federal Trade Cmmissin abut yur rights under the FCRA as a cnsumer with regard t cnsumer reprts and CRAs. By signing belw, I acknwledge review f this Disclsure and receipt f a cpy f A Summary f Yur Rights Under the Fair Credit Reprting Act. Date: Applicant s Signature Applicant s Printed Name Date: Witness Signature Printed Name NAME OF PARISH / SCHOOL, CITY & STATE

3 DISCLOSURE OF RIGHTS AND AUTHORIZATION 1. In cnnectin with my applicatin fr emplyment r vlunteer service with the Dicese f Frt Wayne Suth Bend, Inc. ( Dicese ), I vluntarily request and authrize the Dicese t btain cnsumer reprt infrmatin abut me that is legally btainable under the Fair Credit Reprting Act ( FCRA ) and any applicable state laws frm credit agencies, educatinal institutins, gvernmental agencies, business r persnal references, curts, law enfrcement agencies, military services, and past r present emplyers. While I understand that the Dicese is nly interested in securing criminal histry infrmatin abut me, I als understand that a cnsumer reprt may include infrmatin as t my credit wrthiness, credit standing, credit capacity, character, general reputatin, persnal characteristics, r mde f living, as well as criminal histry infrmatin. I understand that I may request a cmplete and accurate disclsure f the nature and scpe f the backgrund verificatin t the extent such investigatin includes infrmatin bearing n my character, general reputatin, persnal characteristics r mde f living. 2. I specifically authrize the Dicese t btain a cnsumer reprt abut me frm a third party credit reprting agency, namely: First Advantage 1000 Alderman Drive Alpharetta, Gergia Telephne: (866) I grant the Dicese permissin t cnsider the cnsumer reprt when making decisins regarding my ptential emplyment r vlunteer service with the Dicese. 3. I understand that I have rights under the FCRA related t these cnsumer reprts and acknwledge that a summary f thse rights has been prvided t me. 4. I understand that the fllwing infrmatin is required by law enfrcement agencies and ther entities fr psitive identificatin purpses when checking public recrds. It is cnfidential and, as prvided herein, will nt be used by the Dicese fr any ther purpses than securing a cnsumer reprt. AUTHORIZATION (Please print very clearly) Please print yur full name: Please print ther names yu have used: Scial Security Number: Date f Birth: Hme Address: City, State, Zip Cde: Date: Applicant s Signature Applicant s Printed Name Date: Witness Signature Printed Name Name f parish/schl

4 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 fr 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

5 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 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 AttrneyGeneral. Federal enfrcers are: TYPE OF BUSINESS: 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 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 Cmplaints Washingtn, DC Natinal Credit Unin Administratin 1775 Duke Street Alexandria, VA Federal Depsit Insurance Crpratin Cnsumer Respnse Center, 2345 Grand Avenue, Suite 100 Kansas City, Missuri Department f Transprtatin, Office f Financial Management Washingtn, DC Department f Agriculture Office f Deputy Administratr GIPSA Washingtn, DC