Report(s) and investigative consumer report(s) by Company Name Here

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NameReport(s) and investigative consumer report(s) by Company Name Here
A typeReport
Authorization For Consumer Reports
I acknowledge receipt of the separate document entitled DISCLOSURE FOR CONSUMER REPORTS.
I hereby authorize procurement of consumer report(s) and investigative consumer report(s) by Company Name Here (“Company”). If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for Company to procure such reports at any time during my employment, contract, or volunteer period. I authorize without reservation, any person, business or agency contacted by the consumer reporting agency to furnish the above-mentioned information.
This authorization is conditioned upon the following representations of my rights:

I understand that I have the right to make a request to the consumer reporting agency: Integrated Screening Partners (“Agency”), 5316 Hwy. 290 West, Ste., 500, Austin, TX 78735, telephone number (800) 474-4420, upon proper identification, to obtain copies of any reports furnished to Company by the Agency and to request the nature and substance of all information in its files on me at the time of my request, including the sources of information, and the Agency, on Company’s behalf, will provide a complete and accurate disclosure of the nature and scope of the investigation covered by any investigative consumer report(s). The Agency will also disclose the recipients of any such reports on me which the Agency has previously furnished within the two year period for employment requests, and one year for other purposes preceding my request (California three years). I hereby consent to Company obtaining the above information from the Agency. I understand that I can dispute, at any time, any information that is inaccurate in any type of report with the Agency. I may view the Agency’s privacy policy at their website:
I understand that several states such as California, Colorado, Connecticut, Washington, Vermont, etc., as well as some cities, such as New York City restrict employers from requesting and using credit reports except for certain positions or types of business. The Company agrees to follow these restrictions including any written notification requirements.
I understand that certain states such as California, Colorado, Vermont, etc., require a separate disclosure and/or authorization to obtain a consumer’s credit report for employment purposes. If such documentation is required, Company will provide this to me before ordering the credit report.
I understand that several states and cities have enacted “ban-the-box” legislation which restricts when Company can inquire about my criminal history. Company will not inquire before allowed to do so by applicable law, ordinance or regulation.
I understand that where worker’s compensation records are obtainable, that Company will only order the information after a conditional job offer has been made.
I understand that if the Company is located in California, Minnesota or Oklahoma, that I have the right to request a copy of any report Company receives on me. By checking the following box, I request Company to provide a copy of all such reports be sent to me. Check here: 
As a California applicant, I understand that I have the right under Section 1786.22 of the California Civil Code to contact the Agency during reasonable hours (9:00 a.m. to 5:00 p.m. (CST) Monday through Friday) to obtain all information in Agency’s file for my review. I may obtain such information as follows: 1) In person at the Agency’s offices, which address is listed above. I can have someone accompany me to the Agency’s offices. Agency may require this third party to present reasonable identification. I may be required at the time of such visit to sign an authorization for the Agency to disclose to or discuss Agency’s information with this third party; 2) By certified mail, if I have previously provided identification in a written request that my file be sent to me or to a third party identified by me; 3) By telephone, if I have previously provided proper identification in writing to Agency; and 4) Agency has trained personnel to explain any information in my file to me and if the file contains any information that is coded, such will be explained to me.
I understand that if I am applying for employment in New York, that I have the right to receive a copy of Article 23-A of the New York Correction Law __________ (initial if this applies).
I understand that if the report is provided to an employer in the State of Washington, that I can contact the following office for more information regarding my rights under Washington state law in regard to these reports: State of Washington Attorney General, Consumer Protection Division, 800 5th Ave, Ste. 2000, Seattle, Washington 98104-3188, (206) 464-7744.

I understand that I have rights under the Fair Credit Reporting Act, and I acknowledge receipt of the attached Summary of Rights.
Today’s Date____________Signature _ __ Print your full name:__________________________________

Para información en español, visite o escribe a la

Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.
A Summary of Your Rights Under the Fair Credit Reporting Act
The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.
You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment – or to take another adverse action against you – must tell you, and must give you the name, address, and phone number of the agency that provided the information.
You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your “file disclosure”). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:

• a person has taken adverse action against you because of information in your credit report;

• you are the victim of identity theft and place a fraud alert in your file;

• your file contains inaccurate information as a result of fraud;

• you are on public assistance;

• you are unemployed but expect to apply for employment within 60 days.
In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See for additional information.
You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender.
You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See for an explanation of dispute procedures.

Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete, or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate.

Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old.
Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need -- usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access.

You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to
You many limit prescreened” offers of credit and insurance you get based on information in your credit report. Unsolicited “prescreened” offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt out with the nationwide credit bureaus at 1-888-5-OPTOUT (1-888-567-8688).
You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.

Identity theft victims and active duty military personnel have additional rights. For more information, visit
States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. For information about your federal rights, contact:



1.a. Banks, savings associations, and credit

unions with total assets of over $10 billion and

their affiliates
b. Such affiliates that are not banks, savings associations, or credit unions also should list,

a. Consumer Financial Protection Bureau

1700 G Street, N.W.

Washington, DC 20552
b. Federal Trade Commission: Consumer

Response Center – FCRA

in addition to the CFPB:

Washington, DC 20580

(877) 382-4357

2. To the extent not included in item 1 above:
a. National banks, federal savings associations, and federal branches and federal agencies of foreign banks
b. State member banks, branches and agencies of foreign banks (other than federal branches, federal agencies, and Insured State Branches of Foreign Banks), commercial lending

companies owned or controlled by foreign banks, and organizations operating under section 25 or 25A of the Federal Reserve Act
c. Nonmember Insured Banks, Insured State Branches of Foreign Banks, and insured state savings associations
d. Federal Credit Unions

a. Office of the Comptroller of the Currency

Customer Assistance Group

1301 McKinney Street, Suite 3450

Houston, TX 77010-9050
b. Federal Reserve Consumer Help Center

P.O. Box. 1200

Minneapolis, MN 55480

c. FDIC Consumer Response Center

1100 Walnut Street, Box #11

Kansas City, MO 64106
d. National Credit Union Administration Office of Consumer Protection (OCP) Division of Consumer Compliance and Outreach (DCCO)

1775 Duke Street

Alexandria, VA 22314

3. Air carriers

Asst. General Counsel for Aviation

Enforcement & Proceedings

Aviation Consumer Protection Division

Department of Transportation

1200 New Jersey Avenue, S.E. Washington, DC 20590

4. Creditors Subject to the Surface

Transportation Board

Office of Proceedings, Surface Transportation


Department of Transportation

395 E Street, S.W. Washington, DC 20423

5. Creditors Subject to the Packers and

Stockyards Act, 1921

Nearest Packers and Stockyards

Administration area supervisor

6. Small Business Investment Companies

Associate Deputy Administrator for Capital


United States Small Business Administration

409 Third Street, S.W., 8th Floor

Washington, DC 20416

7. Brokers and Dealers

Securities and Exchange Commission

100 F Street, N.E.

Washington, DC 20549

8. Federal Land Banks, Federal Land Bank

Associations, Federal Intermediate Credit

Banks, and Production Credit Associations

Farm Credit Administration

1501 Farm Credit Drive

McLean, VA 22102-5090

9. Retailers, Finance Companies, and All Other

Creditors Not Listed Above

FTC Regional Office for region in which the

creditor operates or Federal Trade

Commission: Consumer Response Center – FCRA

Washington, DC 20580 (877) 382-4357

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