Credit Report Disclosure & Authorization Form

By this document, [Your company] discloses to you that a consumer credit report, including an investigative consumer report containing information about your character, general reputation, personal characteristics and mode of living may be obtained for employment purposes as part of the preemployment background investigation and at any time during your employment.

Should an investigative consumer report be requested, you will have the right to demand a complete and accurate disclosure of the nature and scope of the investigation and a written summary of your rights under the Fair Credit Reporting Act.

[Your company] will respond to a request for detailed information in a written statement to be mailed or otherwise delivered to you no later than five days after the date it receives your written request for additional information or the date the report was first requested, whichever date is later in time.

Please direct any request for additional information to

___________________________________________________

at

___________________________________________________.

Your signature below indicates your authorization for [Your company] to obtain a consumer credit report and/or investigative consumer report about you from a consumer reporting agency.

I acknowlege that I have received a copy of the above notice and that I authorize a copy of my credit report to be released to [Your company] or an investigative consumer report to be requested by [Your company]. 

Date_________________________________________

Signature____________________________________