NOTICE TO SAFESTHIRES CLIENT: The sample dcuments included in this PDF shuld NOT be cnstrued as legal advice, guidance r cunsel. Emplyers shuld cnsult their wn attrney abut their cmpliance respnsibilities under the FCRA and applicable state law, and lcal rdinances. SafestHires expressly disclaims any warranties r respnsibility r damages assciated with r arising ut f these dcuments and the infrmatin prvided therein. Emplyers seeking credit reprts r criminal histry infrmatin may be required t prvide additinal ntices pursuant t state r lcal law, as applicable. BACKGROUND CHECK DISCLOSURE DOCUMENT (the Cmpany ) may rder a cnsumer reprt (a backgrund reprt) n yu frm SafestHires, Inc., a cnsumer reprting agency, in cnnectin with yur emplyment applicatin, and if yu are hired, r if yu already wrk fr the Cmpany, may rder additinal backgrund reprts n yu fr emplyment purpses. The Cmpany may rder an investigative cnsumer reprt. Such reprts typically include infrmatin frm persnal interviews, mst cmmnly frm an applicant s prir emplyers and references. The backgrund reprt may cntain infrmatin cncerning yur character, general reputatin, persnal characteristics, mde f living, criminal histry and credit standing. Infrmatin may be btained frm private and public recrd surces, and fr investigative cnsumer reprts, frm persnal interviews as nted abve. Yu have the right t request mre infrmatin abut the nature and scpe f an investigative cnsumer reprt, if any, by cntacting the Cmpany s department at. THE REMAINDER OF THIS DOCUMENT IS INTENTIONALLY LEFT BLANK. 1 SafestHires Sample Disclsures, Acknwledgements & Authrizatins (May 2017)
NOTICE TO SAFESTHIRES CLIENT: The sample dcuments included in this PDF shuld NOT be cnstrued as legal advice, guidance r cunsel. Emplyers shuld cnsult their wn attrney abut their cmpliance respnsibilities under the FCRA and applicable state law, and lcal rdinances. SafestHires expressly disclaims any warranties r respnsibility r damages assciated with r arising ut f these dcuments and the infrmatin prvided therein. Emplyers seeking credit reprts r criminal histry infrmatin may be required t prvide additinal ntices pursuant t state r lcal law, as applicable. BACKGROUND CHECK AUTHORIZATION DOCUMENT By signing belw, I authrize the Cmpany t rder my backgrund check. I understand that, as allwed by law, the Cmpany may rely n this authrizatin t rder additinal backgrund reprts withut asking me fr my authrizatin again during my emplyment. Fr the purpse f preparing a backgrund check fr the Cmpany, and nly fr that specific purpse, and subject t all laws prtecting my infrmatinal and individual privacy, I als authrize the fllwing t disclse t the CRA the infrmatin needed t cmpile the reprt: my past r present emplyers; learning institutins, including clleges and universities; law enfrcement and all ther federal, state and lcal agencies; federal, state and lcal curts; the military; mtr vehicle recrds agencies; credit bureaus, drug/alchl testing facilities; and licensing/credentialing agencies. By signing belw, I acknwledge the infrmatin that can be disclsed t the CRA, if and nly as allwed by law, includes infrmatin cncerning my emplyment and earnings histry, educatin, credit histry, mtr vehicle histry, criminal histry, military service, prfessinal credentials and licenses and drug/alchl test results. Last Name First Middle Maiden/Other Names Years Used Scial Security Number Driver s License Number State Other Driver s Licenses Held in Past 5 Years State FOR IDENTIFICATION PURPOSES ONLY: Date f Birth / / (Mnth / Day / Year) Signature / / Tday s Date (Mnth/Day/Year) THE REMAINDER OF THIS DOCUMENT IS INTENTIONALLY LEFT BLANK. 1 SafestHires Sample Disclsures, Acknwledgements & Authrizatins (May 2017)
Para infrmación en españl, visite www.cnsumerfinance.gv/learnmre escribe a la Cnsumer Financial Prtectin Bureau, 1700 G Street N.W., Washingtn, DC 20552. 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 FCRA. Fr mre infrmatin, including infrmatin abut additinal rights, g t www.cnsumerfinance.gv/learnmre r write t: Cnsumer Financial Prtectin Bureau, 1700 G Street N.W., Washingtn, DC 20552. 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 identity 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, all cnsumers are entitled t ne free disclsure every 12 mnths upn request frm each natinwide credit bureau and frm natinwide specialty cnsumer reprting agencies. See www.cnsumerfinance.gv/learnmre 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 1
reprting agency, the agency must investigate unless yur dispute is frivlus. See www.cnsumerfinance.gv/learnmre 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 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 www.cnsumerfinance.gv/learnmre. 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 1-888-5-OPTOUT (1-888-567-8688). The fllwing FCRA right applies with respect t natinwide cnsumer reprting agencies: CONSUMERS HAVE THE RIGHT TO OBTAIN A SECURITY FREEZE Yu have a right t place a security freeze n yur credit reprt, which will prhibit a cnsumer reprting agency frm releasing infrmatin in yur credit reprt withut yur express authrizatin. The security freeze is designed t prevent credit, lans, and services frm being apprved in yur name withut yur cnsent. Hwever, yu shuld be aware that using a security freeze t take cntrl ver wh gets access t the persnal and financial infrmatin in yur credit reprt may delay, interfere with, r prhibit the timely apprval f any subsequent request r applicatin yu make regarding a new lan, credit, mrtgage, r any ther accunt invlving the extensin f credit. As an alternative t a security freeze, yu have the right t place an initial r extended fraud alert n yur credit file at n cst. An initial fraud alert is a 1-year alert that is 2
placed n a cnsumer s credit file. Upn seeing a fraud alert display n a cnsumer s credit file, a business is required t take steps t verify the cnsumer s identity befre extending new credit. If yu are a victim f identity theft, yu are entitled t an extended fraud alert, which is a fraud alert lasting 7 years. A security freeze des nt apply t a persn r entity, r its affiliates, r cllectin agencies acting n behalf f the persn r entity, with which yu have an existing accunt that requests infrmatin in yur credit reprt fr the purpses f reviewing r cllecting the accunt. Reviewing the accunt includes activities related t accunt maintenance, mnitring, credit line increases, and accunt upgrades and enhancements. 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 www.cnsumerfinance.gv/learnmre. 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. Fr infrmatin abut yur federal rights, cntact: 3
TYPE OF BUSINESS: 1.a. Banks, savings assciatins, and credit unins with ttal assets f ver $10 billin and their affiliates b. Such affiliates that are nt banks, savings assciatins, r credit unins als shuld list, in additin t the CFPB: 2. T the extent nt included in item 1 abve: a. Natinal banks, federal savings assciatins, and federal branches and federal agencies f freign banks b. State member banks, branches and agencies f freign banks (ther than federal branches, federal agencies, and Insured State Branches f Freign Banks), cmmercial lending cmpanies wned r cntrlled by freign banks, and rganizatins perating under sectin 25 r 25A f the Federal Reserve Act. c. Nnmember Insured Banks, Insured State Branches f Freign Banks, and insured state savings assciatins CONTACT: a. Cnsumer Financial Prtectin Bureau 1700 G Street, N.W. Washingtn, DC 20552 b. Federal Trade Cmmissin Cnsumer Respnse Center 600 Pennsylvania Avenue, N.W. Washingtn, DC 20580 (877) 382-4357 a. Office f the Cmptrller f the Currency Custmer Assistance Grup 1301 McKinney Street, Suite 3450 Hustn, TX 77010-9050 b. Federal Reserve Cnsumer Help Center P.O. Bx 1200 Minneaplis, MN 55480 c. FDIC Cnsumer Respnse Center 1100 Walnut Street, Bx #11 Kansas City, MO 64106 d. Federal Credit Unins d. Natinal Credit Unin Administratin Office f Cnsumer Financial Prtectin (OCFP) Divisin f Cnsumer Cmpliance Plicy and Outreach 1775 Duke Street Alexandria, VA 22314 3. Air carriers Asst. General Cunsel fr Aviatin Enfrcement & Prceedings Aviatin Cnsumer Prtectin Divisin Department f Transprtatin 1200 New Jersey Avenue, S.E. Washingtn, DC 20590 4. Creditrs Subject t the Surface Transprtatin Bard Office f Prceedings, Surface Transprtatin Bard Department f Transprtatin 395 E Street, S.W. Washingtn, DC 20423 5. Creditrs Subject t the Packers and Stckyards Act, 1921 Nearest Packers and Stckyards Administratin area supervisr 6. Small Business Investment Cmpanies Assciate Deputy Administratr fr Capital Access United States Small Business Administratin 409 Third Street, S.W., Suite 8200 Washingtn, DC 20416 7. Brkers and Dealers Securities and Exchange Cmmissin 100 F Street, N.E. Washingtn, DC 20549 8. Federal Land Banks, Federal Land Bank Assciatins, Federal Intermediate Credit Banks, and Prductin Credit Assciatins 9. Retailers, Finance Cmpanies, and All Other Creditrs Nt Listed Abve Farm Credit Administratin 1501 Farm Credit Drive McLean, VA 22102-5090 Federal Trade Cmmissin Cnsumer Respnse Center 600 Pennsylvania Avenue, N.W. Washingtn, DC 20580 (877) 382-4357 4