EMPLOYMENT CREDIT REPORT

Similar documents
EMPLOYMENT CREDIT REPORT

A Summary of Your Rights Under the Fair Credit Reporting Act

Pre-Adverse Action Notice

Consumer Dispute Form

ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK

BACKGROUND CHECK DISCLOSURE DOCUMENT

Chadron State College

REINVESTIGATION REQUEST

PERSONAL INQUIRY WAIVER AUTHORITY FOR RELEASE OF INFORMATION FORM (Consumer Disclosure and/or Investigation for Background Check)

BRIGHTPOINT Background check authorization form

Disclosure Regarding Employment Background Report ( COMPANY ) may obtain from Sterling Infosystems, Inc. ( STERLING ), 1 State Street, New York, NY

Disclosure & Authorization Regarding Procurement of An Investigative Consumer Report

DISCLOSURE OF BACKGROUND INVESTIGATION

The following is for identification purposes only to perform the background check and will not be used for any other purpose:

Penn State Health CONSENT AND AUTHORIZATION FORM ADDITIONAL STATE LAW NOTICES

GREAT PLAINS TECHNICAL SERVICES

13719 W. Greenfield Ave. PO Box New Berlin, WI 53151

Application for Employment

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

Chadron State College

Contractor Disclosure, Authorization & Consent for the Procurement of Consumer Reports

First Name: KATHRYN Date of Birth (DOB): Middle Name: ALICE Social Security Number (SSN): ***-**-2664 Last Name: BRANNAN

Disclosure. Please sign below to acknowledge your receipt of this disclosure. Printed Name

DISCLOSURE AND AUTHORIZATION FOR CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT. Company Name:

DISCLOSURE AND AUTHORIZATION

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

NEPTUNE ASSOCIATES LLC

check on you, please complete the information below and include all past or current names used (e.g., maiden, surname, alias).

Brunswick Senior Resources, Inc.

FCRA SUMMARY OF RIGHTS

BACKGROUND CHECK DISCLOSURE

COMPANYNAME. Address City, State, ZIP

BACKGROUND CHECK DISCLOSURE AND AUTHORIZATION FORM

DISCLOSURE AND AUTHORIZATION FOR CONSUMER REPORTS

BACKGROUND CHECK DISCLOSURE & AUTHORIZATION

DISCLOSURE AND AUTHORIZATION FOR CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT. Company Name:

Motor Vehicle Report Risk Management Authorization

ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK

4B. Can you perform the essential job functions required of the position for which you are applying with or without accommodation?

BACKGROUND CHECK DISCLOSURE & AUTHORIZATION

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

Disclosure Statement and Authorization

Applicant Information. Street Address Apartment/Unit # City State ZIP Code. Date Available: Social Security No.: Desired Salary:$ If yes, when?

Volunteer Service Agreement

Disclosure Regarding Background Investigation

BACKGROUND CHECK DISCLOSURE

A Summary of Your Rights Under the Fair Credit Reporting Act

NAME OF PARISH/SCHOOL REQUESTING SEARCH AND THAT SHOULD RECEIVE BILL AND RESULTS

Account Application Type of Account CASH CHARGE (circle one)

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

TENANT FORM DISCLOSURE AND AUTHORIZATION FOR CONSUMER REPORT AND/OR INVESTIGATIVE CONSUMER REPORT. Landlord / Property Manager:

Contractor Disclosure, Authorization & Consent for the Procurement of Consumer Reports

BACKGROUND CHECK DISCLOSURE AND AUTHORIZATION FORM

ALDINEISD OBSERVATION HOURS. Date: Student Name: Address: Phone Number: University: Campus (where you would like to observe):

AUTHORIZATION FOR BACKGROUND CHECKS

DISCLOSURE AND AUTHORIZATION FOR CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT. Company Name:

Candidate Disclosure, Authorization & Consent for the Procurement of Consumer Reports

DISCLOSURE OF PROCUREMENT OF CONSUMER REPORT

Authorization for Consumer Reports and Investigative Consumer Reports

Background Report Dispute

DISCLOSURE REGARDING BACKGROUND CHECK

KANSAS STATE UNIVERSITY

CONSUMER AUTHORIZATION Fax Completed Documents to GIS at (866)

Date. Signature of Legal Parent or Guardian. Print Name

Motor Vehicle Report Risk Management Authorization

Employment Application

First Name: JUAN Date of Birth (DOB): Middle Name: CARLOS Social Security Number (SSN): ***-**-5054 Last Name: LOFTS

Disclosure Regarding Background Investigation

Producer Background Questionnaire and Data Sheet

The Starke County Youth Club, Inc. NOTICE TO VOLUNTEERS REGARDING BACKGROUND INVESTIGATION AUTHORIZATION

United American Application Packet

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

Background Questionnaire

CITY OF DARIEN SOLICITOR LICENSE APPLICATION

Fixed Life Transmittal. The Field Marketing Organization (FMO) that I will be selling my Fixed Life business with is

Adverse Action Guide for Employers: A Simplified Guide to the Fair Credit Reporting Act

Score generated using a foreign data score of 756 provided by CRIF High Mark. More details below. The risk pro le of this applicant is low

BACKGROUND CHECK DISCLOSURE

Equal Opportunity Employer Employment Application

EMPLOYMENT APPLICATION

ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK

YMCA of Metropolitan Denver Volunteer Requirements

Application for Employment

VOLUNTEER APPLICATION

EMPLOYMENT APPLICATION

A Summary of Your Rights Under the Fair Credit Reporting Act

BACKGROUND CHECK DISCLOSURE AND AUTHORIZATION FORM

Playing Membership Application

DISCLOSURE REGARDING BACKGROUND INVESTIGATION FOR ALL EMPLOYMENT CANDIDATES (REGARDLESS OF LOCATION):

**THERE WILL BE NO FURTHER NOTICE OF THESE TESTING DATES AND NO MAKE-UP DATES.**

Volunteer Information

( ) ( ) Cell Phone Home Phone Address

DIOCESE OF CHARLESTON BACKGROUND SCREENING BASIC DATA FORM Forms must be completed in their entirety to be processed.

Name: Last First Middle Initial. City State Zip Code Cell Phone: ( ) - Emergency Cell Phone: ( ) - Other Phone: ( ) -

DISCLOSURE CONCERNING REQUEST FOR BACKGROUND CHECK REPORT

A Summary of Your Rights Under the Fair Credit Reporting Act

Job Application. Northwood Deaconess Health Center. 4 North Park Street Northwood, ND

DISCLOSURE REGARDING BACKGROUND INVESTIGATION IMPORTANT -- PLEASE READ CAREFULLY BEFORE SIGNING AUTHORIZATION

City of Moline Career Opportunity

REINVESTIGATION REQUEST

Transcription:

Subscriber Name: ACCUSCREEN S Subscriber Code/Market: Z 3525513 15 62 Results Issued: 8/04/15 14:23 CT EMPLOYMENT CREDIT REPORT INPUT PARAMETERS FOR PRIMARY SUBJECT Reference ID: SSN: XXX-XX-8640 Name: Current Address: LeBourgeois, Carmen 10817 Pinebrook Ave Baton Rouge LA.70809 ARAYA, CARMEN V. Also Known As: GRAY,CARMEN,V Current Address: 8909 WORTHINGTON ESTATES AV. BATON ROUGE LA. 70810 Previous Address: 10160 OLIPHANT RD. BATON ROUGE LA. 70809 Reported 9/09 Reported 8/05 SSN: 241-59-8640 Date of Birth: Phone Number: Previous Address: 10817 PINEBROOK AV. BATON ROUGE LA. 70809 In File Since: 2/88 EMPLOYMENT DATA REPORTED NEIGHBORS FEDERAL CREDIT UNION Position: FINANCIAL SERVICE Salary: Reported 7/09 Verified 8/09 UFOHO1 FOLEYS Reported 11/03 SDGE Reported 3/98 ALERTS AND SPECIAL MESSAGES Type ID MISMATCH ALERT Position: Salary: Position: Salary: Explanation INPUT SURNAME DOES NOT MATCH FILE SURNAME CREDIT INFORMATION Summary (Total History) Public Records: 0 Collections: 2 Trades: 12 Inquiries: 1 Negative Trade Accounts: 4 Trade Accounts with Any Historical Negatives: 3 Occurrence of Historical Negatives: 10 Count High Credit Credit Limit Balance Past Due Payment Available Closed w/balance- n/a n/a $842 $842 $0 Total 12 $0 $0 $842 $842 $0 n/a COLLECTIONS The following items are Collections records: FST NAT COLL (Y 2C8C001) Original Creditor: DIRECTV(cableOrCellular) Account Type: OPEN Responsibility: I Remarks: PLACED FOR COLLECTION Account Rating O9B Amount Placed: $588 Opened: 11/11 Balance: $588 Paid: Past Due: $588 Closed: Last Payment: Verified: 7/12 STRN CR REC (Y 649J003) Original Creditor: MEDICAL(medicalOrHealth Care) Account Type: OPEN Responsibility: I Account Rating O9P Remarks: PAID COLLECTION Amount Placed: $69 Opened: 4/12 Balance: $0 Paid: 10/12 Past Due: $0 Closed: 10/12 Last Payment: Verified: 10/12

TRADES Page: 2 of 6 ENTERGY GS (U 01KKP004) Account Rating O09 Account Type: OPEN Credit Limit: Balance: $842 Opened: 11/10 Loan Type: UTILITY COMPANY High Credit: $842 Past Due: $842 Paid: Responsibility: I Terms: Closed: 3/11 Remarks: UNPAID BALANCE CHARGED OFF Verified: 3/11 Months 1-12: Account Rating I03 Account Type: INSTALLMENT Credit Limit: Balance: $0 Opened: 6/09 Loan Type: SECURED High Credit: $5,529 Past Due: $0 Paid: Responsibility: I Terms: 45M167 Closed: 3/11 Remarks: CLOSED Verified: 3/11 Months 1-12: 211111111121 211111111 RELIABLE CDT (F 082UR001) Account Rating I02 Account Type: INSTALLMENT Credit Limit: Balance: $0 Opened: 3/10 Loan Type: SECURED BY HOUSEHOLD GOODS High Credit: $2,784 Past Due: $0 Paid: Responsibility: I Terms: 24M116 Closed: 8/11 Remarks: CLOSED Verified: 8/11 11111 Account Rating I02 Account Type: INSTALLMENT Credit Limit: Balance: $0 Opened: 12/08 Loan Type: UNSECURED High Credit: $2,568 Past Due: $0 Paid: Responsibility: I Terms: 33M103 Closed: 7/11 Remarks: CLOSED Verified: 7/11 112121111111 Account Type: INSTALLMENT Credit Limit: Balance: $0 Opened: 3/11 Loan Type: SECURED High Credit: $6,202 Past Due: $0 Paid: Responsibility: S Terms: 42M178 Closed: 1/15 Remarks: CLOSED Verified: 1/15 Months 1-12: 111111111112 222111111111

TRADES Page: 3 of 6 Account Type: INSTALLMENT Credit Limit: Balance: $0 Opened: 3/11 Loan Type: SECURED High Credit: Past Due: $0 Paid: Responsibility: S Terms: 36M181 Closed: 3/11 Remarks: CLOSED Verified: 3/11 Months 1-12: RELIABLE CDT (F 082UR001) Account Type: INSTALLMENT Credit Limit: Balance: $0 Opened: 7/09 Loan Type: SECURED BY HOUSEHOLD High Credit: $1,512 Past Due: $0 Paid: GOODS Responsibility: I Terms: 24M63 Closed: 3/10 Remarks: ACCOUNT CLOSED DUE TO Verified: 3/10 REFINANCE Months 1-12: 11111111 Account Type: INSTALLMENT Credit Limit: Balance: $0 Opened: 8/07 Loan Type: SECURED High Credit: $6,672 Past Due: $0 Paid: Responsibility: I Terms: 54M185 Closed: 6/09 Remarks: CLOSED Verified: 6/09 1111111111 Account Type: INSTALLMENT Credit Limit: Balance: $0 Opened: 6/08 Loan Type: UNSECURED High Credit: $2,272 Past Due: $0 Paid: Responsibility: I Terms: 24M117 Closed: 12/08 Remarks: CLOSED Verified: 12/08 Months 1-12: 111111 Account Type: INSTALLMENT Credit Limit: Balance: $0 Opened: 10/08 Loan Type: UNSECURED High Credit: $2,000 Past Due: $0 Paid: Responsibility: I Terms: Closed: 10/08 Remarks: CLOSED Verified: 10/08 Months 1-12:

TRADES Page: 4 of 6 Account Type: INSTALLMENT Credit Limit: Balance: $0 Opened: 12/07 Loan Type: UNSECURED High Credit: $1,003 Past Due: $0 Paid: Responsibility: I Terms: 18M66 Closed: 6/08 Remarks: CLOSED Verified: 6/08 Months 1-12: 111111 Account Type: INSTALLMENT Credit Limit: Balance: $0 Opened: 12/06 Loan Type: UNSECURED High Credit: $1,003 Past Due: $0 Paid: Responsibility: I Terms: 18M66 Closed: 12/07 Remarks: CLOSED Verified: 12/07 INQUIRIES Date Subscriber Name Subscriber Code Contact Subscriber at 8/04/15 ACCUSCREEN S Z03525513 REPORT SERVICED BY TRANSUNION (800) 888-4213 P.O. BOX 1000, CHESTER, PA 19022 CONSUMER DISCLOSURES CAN BE OBTAINED ONLINE THROUGH TRANSUNION AT: HTTP://WWW.TRANSUNION.COM

Page: 5 of 6 A Summary of Your Rights Under the Fair Credit Reporting Act Para informacion en espanol, visite www.consumerfinance.gov/learnmore o escribe a la Consumer Financial Protection Bureau,1700 G Street N.W., Washington, DC 20006. The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to www.consumerfinance.gov/learnmore, or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20006. You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment -- or to take another adverse action against you -- must tell you, and must give you the name, address, and phone number of the agency that provided the information. You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your "file disclosure"). You will be required to provide proper identification, which may include your Social Security Number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if: A person has taken adverse action against you because of information in your credit report; You are the victim of identity theft and place a fraud alert in your file; Your file contains inaccurate information as a result of fraud; You are on public assistance; You are unemployed but expect to apply for employment within 60 days. In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.consumerfinance.gov/learnmore for more information. You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender. You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See www.consumerfinance.gov/learnmore for an explanation of dispute procedures. Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete, or unverifiable information must be removed or corrected, usually within 30 days. However a consumer reporting agency may continue to report information it has verified as accurate. Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old. Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need - usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access. You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to www.consumerfinance.gov/learnmore. You may limit "prescreened" offers of credit and insurance you get based on information in your credit report. Unsolicited "prescreened" offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-567-8688 (888-5OPTOUT). You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court. Identity theft victims and active duty military personnel have additional rights. For more information, visit www.consumerfinance.gov/learnmore.

EMPLOYMENT CREDIT REPORT Page: 6 of 6 States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. For information about your federal rights, contact: TYPE OF BUSINESS: 1.a. Banks, savings associations, and credit unions with total assets of over $10 billion and their affiliates b. Such affiliates that are not banks, savings associations, or credit unions also should list, in addition to the Bureau: 2. To the extent not included in item 1 above: a. National banks, federal savings associations, and federal branches/ and federal agencies of foreign banks b. State member banks, branches and agencies of foreign banks (other than federal branches/, federal agencies, and insured state branches of foreign banks), commercial lending companies owned or controlled by foreign banks, and organizations operating under section 25 or 25A of the Federal Reserve Act c. Nonmember Insured Banks, Insured State Branches of Foreign Banks, and Insured state savings associations CONTACT: Bureau of Consumer Financial Protection 1700 G Street NW Washington, DC 2006 Federal Trade Commission Consumer Response Center - FCRA Washington, DC 20580 1-877-382-4357 Office of the Comptroller of the Currency Customer Assistance Group 1301 McKinney Street, Suite 3450 Houston, TX 77010-9050 1-800-613-6743 Federal Reserve Consumer Help (FRCH) PO Box 1200 Minneapolis, MN 55480 1-888-851-1920 Website Address: www.federalreserveconsumerhelp.gov Email Address: ConsumerHelp@FederalReserve.gov FDIC Consumer Response Center 1100 Walnut Street, Box #11 Kansas City, MO 64106 d. Federal credit unions National Credit Union Administration Office of Consumer Protection (OCP) Division of Consumer Compliance and Outreach (DCCO) 1775 Duke Street Alexandria, VA 22314 1-703-519-4600 3. Air carriers Asst. General Counsel for Aviation Enforcement & Proceedings Department of Transportation 400 Seventh Street SW Washington, DC 20590 1-202-366-1306 4. Creditors Subject to Surface Transportation Board Office of Proceedings, Surface Transportation Board Department of Transportation 1925 K Street NW Washington, DC 20423 5. Creditors subject to Packers and Stockyards Act Nearest Packers and Stockyards Administration area supervisor 6. Small Business Investment Companies Associate Deputy Administrator for Capital Access United States Small Business Administration 406 Third Street, SW, 8th Floor Washington, DC 20416 7. Brokers and Dealers Securities and Exchange Commission 100 F St NE Washington, DC 20549 8. Federal Land Banks, Federal Land Bank Associations, Federal Intermediate Credit Banks, and Production Credit Associations 9. Retailers, Finance Companies, and All Other Creditors Not Listed Above Farm Credit Administration 1501 Farm Credit Drive McLean, VA 22102-5090 FTC Regional Office for region in which the creditor operates or Federal Trade Commission: Consumer Response Center- FCRA Washington, DC 20580 1-877-382-4357 END OF TRANSUNION REPORT Achieve more TM with TransUnion