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- I understand that an investigative report may be generated on me that may include information as to my character, work habits, performance and experience, along with reasons for termination of past employment/professional license or credentials; financial/credit history; or criminal/civil/driving record history. I give my full consent, and understand that you may be requesting information from public and private sources about any of the information noted earlier in this paragraph.
- IF APPLICABLE, Medical and workers compensation information will only be requested in compliance with the Federal Americans with Disabilities Act (ADA) and/or any other applicable state laws. According to the Fair Credit Reporting Act (FCRA, Public Law 91-508, Title VI) that was revised effective September 30, 1997, I am entitled to know if the considerations for which I am applying are denied because of information obtained from a consumer-reporting agency. If so, I will be notified and be given the name of the agency providing that report.
- I acknowledge that a telephonic facsimile (FAX) or photographic copy of this release shall be as valid as the original. This release is valid for most federal, state and county agencies.
- Minnesota/California/Oklahoma applicants only. If you want a copy of the consumer report ordered, check here . The report will be sent by the consumer-reporting agency to you at the address listed below your signature.
- I hereby authorize, without reservation for the duration of my employment, any financial institution, law enforcement agency, information service bureau, school, employer or insurance company contacted by General Information Services, Inc. to furnish the information described in Section I.
Applicants Must Complete The Following:
Please print full name:
Today’s Date:
Signature:
The following information is required by law enforcement agencies and other entitles for positive identification purposes when checking public records. It is confidential and will not be used for any other purposes.
Please print other names you have used:
Social Security Number:
Date of Birth:
Home Address:
City, State, ZIP:
Driver’s License Number and State Name as it appears on license:
Have you ever been convicted of a crime? ____ No ____ Yes
If yes, please provide city and state, and details of conviction.
FAIR CREDIT REPORTING ACT NOTICE
In accordance with the Fair Credit Reporting Act (FCRA, Public Law 91-508, Title VI), revised effective September 30, 1997 , this information may only be used to verify a statement(s) made by an individual in connection with legitimate business needs. The depth of information available varies from state to state. Status of updates are available on request. Although every effort has been made to ensure accuracy, General Information Services, Inc. cannot act as guarantor of information accuracy or completeness. Final verification of an individual’s identity and proper use of report contents are the user's responsibility. General Information Services, Inc.’s policy requires purchasers of these reports to have signed a Service Agreement. This assures General Information Services, Inc. that users are familiar with and will abide by their obligations, as stated in the FCRA, revised effective September 30, 1997, to the individuals named in these reports. If information contained in this report is responsible for the suspension or termination of an employee or the application process, the applicant/employee should contact General Information Services, Inc.