Fair Credit Reporting Act Disclosure

In conjunction with my application for employment (including contract services) with you, my prospective employer, I understand that you intend to hire All Clear Employee Screening to obtain Consumer Reports and/or Investigative Consumer Reports (hereinafter called “Reports”) about me as defined in the Fair Credit Reporting Act (FCRA). These “Reports” may include information concerning my credit worthiness,
credit standing, credit capacity, character, academic background, credentials, work habits, work performance, work experience, reasons for work termination, general reputation, personal characteristics or mode of living. You also may seek information concerning my employment history, workers’ compensation history,
motor vehicle record, education background, civil litigation history and/or criminal record.

I understand that you may rely on any or all of the above referenced information in determining whether
to extend an offer of employment to me. If you contemplate making an adverse employment-related decision that will affect me based, in whole or in part, upon a “Report” obtained from Selection.com,
I will be provided with a copy of the “Report” and a written summary of my Consumer Rights under
the FCRA before you finalize that decision.

I have read the above disclosure and I hereby authorize you, All Clear Employee Screening or its authorized agents to obtain the above referenced information about me. I also authorize all agencies, bureaus,
employers, information service organizations and individuals to provide any of the above referenced knowledge or information they have concerning me. If I am hired, this authorization shall remain on file
and shall serve as an ongoing authorization for you to obtain “Reports” about me form All Clear Employee Screening at any time during my employment with you. A photocopy or facsimile of this authorization shall
be as valid as the original. I agree that any and all disputes arising from this “Report” shall be brought only
in state or federal court in the State of Florida and shall be governed by, and construed in accordance with,
the laws of the State of Florida.

Print Name* (Required)

Date* (Required)

This form is for permanent retention in personnel file.

 

Employment Inquiry Release

In conjunction with my application for employment (including contract services) with you, my prospective employer, I understand that you intend to hire All Clear Employee Screening to obtain Consumer Reports and/or Investigative Consumer Reports (hereinafter called “Reports”) about me as defined in the Fair Credit Reporting Act (FCRA). These “Reports” may include information concerning my credit worthiness, credit standing, credit capacity, character, academic background, credentials, work habits, work performance, work experience, reasons for work termination, general reputation, personal characteristics or mode of living. You also may seek information concerning my employment history, workers’ compensation history, motor vehicle record, education background, civil litigation history and/or criminal record.

I understand that you may rely on any or all of the above referenced information in determining whether to extend an offer of employment to me. If you contemplate making an adverse employment-related decision that will affect me based, in whole or in part, upon a “Report” obtained from All Clear Employee Screening, I will be provided with a copy of the “Report” and a written summary of my Consumer Rights under the FCRA before you finalize that decision.

I have read the above disclosure and I hereby authorize you, All Clear Employee Screening or its authorized agents to obtain the above referenced information about me. I also authorized all agencies, bureaus,
employers, information service organizations and individuals to provide any of the above referenced knowledge or information they have concerning me. If I am hired, this authorization shall remain on file and shall serve as an ongoing authorization for you to obtain “Reports” about me from All Clear Employee Screening at any time during my employment with you. A photocopy or facsimile of this authorization shall be as valid as the original. I agree that any and all disputes arising from this “Report” shall be brought only
in state or federal court in the State of Florida and shall be governed by, and construed in accordance with, the laws of the State of Florida.

Print Name* (Required)

Date* (Required)

THE FOLLOWING INFORMATION IS REQUIRED TO CONDUCT THE BACKGROUND INVESTIGATION

Last, First, Middle Name* (Required)

Previous or Maiden Name

Phone Number* (Required)

Street Address* (Required)

City, State, Zip* (Required)

Driver's License Number* (Required)

State Issued* (Required)

List states and counties of residence, other than above, for the past seven (7) years:

County, State* (Required)

County, State* (Required)

County, State* (Required)

For identification purposes only:

Date of Birth* (Required)

Sex* (Required)

Race* (Required)

My prospective employer recognizes that age, sex and race are protected characteristics and that the information requested will not be used as the basis for any employment decision.

 

Click the icon to download, complete, and bring the Inquiry Release form with you to your appointment.

PDF-Icon  All Clear Employee Screening Inquiry Release Form