CREDIT HISTORY AND CRIMINAL BACKGROUND CHECK AUTHORIZATION by rrw12991

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									     CREDIT HISTORY AND CRIMINAL BACKGROUND CHECK AUTHORIZATION
The following information is required by law enforcement agencies and other positive identification purposes when
checking public records. It is confidential and will not be used for any other purposes.

                                                               PLEASE PRINT
  First Name:                               Middle Name:                     Last Name:         Maiden Name (if applicable):



  Current Address (Street, City, State, Zip Code):



  Previous Address (Street, City, State, Zip Code):



  Social Security Number:                                  Drivers License Number:              State of Issuance:




I hereby authorize Guaranty Bond Bank and its designated agents and representatives to conduct a comprehensive review
of my credit history and criminal background through a consumer report and/or an investigative consumer report. I certify
that I have received and read the FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT provided to me
and that I understand the disclosure statement. I understand that the scope of the consumer report/investigative consumer
report may include, but is not limited to, information as to my character, general reputation, discerned through
employment and education verifications; personal references; personal interviews; my personal credit history based on
reports from any credit bureau; my driving history, including any traffic citations; a social security number verification;
present and former addresses; criminal and civil history/records; any other public record. This authorization shall be valid
in original, photocopy, or telephonic facsimile form.

I further authorize any person, business entity or governmental agency who may have information relevant to the above to
disclose the same to Guaranty Bond Bank and its designated agents and representatives, including, but not limited to any
and all courts, public agencies, law enforcement agencies and credit bureaus, regardless of whether such person, business
entity or governmental agency compiled the information itself or received it from other sources.

I understand that before I am denied employment based, in whole or part, on information obtained in the report(s), I will
be provided a copy of the report(s) and a description in writing of my rights under the Fair Credit Reporting Act.

I also understand if I disagree with the accuracy of any information in the report(s), I must notify Guaranty Bond Bank
within two days of my receipt of the report(s). If I notify Guaranty Bond Bank within two days of the receipt of the
report(s) that I am challenging information in the report(s), Guaranty Bond Bank will not make a final decision on my
employment status until after I have had a reasonable opportunity to address the information contained in the report(s).

I hereby release Guaranty Bond Bank and its designated agents and representatives, and any and all persons, business
entities and governmental agencies, whether public or private, from any and all liability, claims and/or demands, by me,
my heirs or others making such claim or demand on my behalf, for providing a consumer report and/or investigative
consumer report hereby authorized.

I understand that if my application for employment is granted, this Credit History and Criminal Background Check
Authorization shall remain in effect for the duration of my employment with Guaranty Bond Bank.

I certify that answers given herein are true and complete. I understand that false or misleading information given in my
application or interview(s) may result in discharge.

Signature:                                                                                  Date:

								
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