DISCLOSURE AND AUTHORIZATION FOR EMPLOYEES/CONTRACTORS

[IMPORTANT -- PLEASE READ CAREFULLY BEFORE SIGNING AUTHORIZATION]

Disclosure Regarding Background Investigation

In connection with your application to work at Faith Chapel Christian Center, Inc., which may be deemed “employment purposes” under the Fair Credit Reporting Act, you may be the subject of a “consumer report” and/or an “investigative consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources such as your neighbors, friends or associates. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records (“driving records”), verification of your education or employment history, military records, professional licensure records, drug testing, or other background checks.  Credit history will only be requested where such information is substantially related to the duties and responsibilities of the position for which you are applying.  These reports may contain information concerning the reasons for termination of past employment. You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you, and disclosure of the nature and scope of any investigative consumer report and to request a copy of your report.  Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment services is an investigation into your education and/or employment history conducted by SecureSearch, Consumer Disputes, 558 Castle Pines Pkwy., #B4-137, Castle Rock, CO 80108, (866) 891 – 1954, www.securesearchpro.com, or another outside organization. The scope of this notice and authorization is all encompassing, however, allowing the Company to obtain from any outside organization all manner of consumer reports and investigative consumer reports now and throughout the course of your employment service to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report.

ACKNOWLEDGMENT AND AUTHORIZATION

Authorization

I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION AND A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize, without reservation, the obtaining of “consumer reports” or “investigative consumer” reports by Faith Chapel Christian Center, Inc. at any time after receipt of this authorization and throughout my employment service, if applicable. I further authorize and request, without reservation, any present or former employer, school or university (public or private), any law enforcement agency, administrator, state or federal agency, institution, division of motor vehicles, information service bureau, insurance company, consumer reporting agencies, or other persons or agencies to furnish any and all background information requested by SecureSearch, Consumer Disputes, 558 Castle Pines Pkwy., #B4-137, Castle Rock, CO 80108, (866) 891-1954, www.securesearchpro.com, another outside organization acting on behalf of the Company, and/or the Company itself. I also agree that a fax, electronic or photocopy of this Authorization with my signature shall be as valid as the original.

 

The following is information required in order for Faith Chapel Christian Center, Inc. to obtain a complete consumer report:

 
(First, Full Middle Name, Last Name)
Date of Birth *
Date of Birth
Street Address
Street Address
Best Contact Phone *
Best Contact Phone
(AKA, Maiden Names, Married Names, Surnames, etc.)