Common use of ACKNOWLEDGEMENT AND AUTHORIZATION Clause in Contracts

ACKNOWLEDGEMENT AND AUTHORIZATION. By signing below, I hereby authorize the obtaining of consumer reports and/or investigative consumer reports by the Company at any time after receipt of this authorization and throughout the course of my employment, if applicable. Signature: _ _ Date: _ First Name: _Middle Name: _ Last Name: _ Last Four Digits of SSN: __ _ In connection with my application for employment, I direct the following regarding my current employer: (please check one). Yes, my current employer may be contacted / No, my current employer cannot be contacted I understand that I have rights under the Fair Credit Reporting Act, and I acknowledge receipt of the Summary of Rights (initials). I authorize Company and Agency to use email communication with me to provide me with notices and information regarding any report or use of such report. If I do not have an email address or do not wish to share it, then communication will be by U.S. Mail, which will result in slower communication. If you have any questions concerning this background screening content, please contact: AmericanChecked, Inc. (Agency) at (000) 000-0000. Printed Full Name: Signature: Date: _/ / Company Name: _ Current Address: City State Zip Previous Address City State Zip For identification purposes: Social Security No.: Date of Birth: Driver’s License No.: _ _ _ State of Issue: _ Massachusetts applicants/employees only: The precise nature and scope of any investigative consumer report will be the same as described in Background Check Disclosure. You have a right to obtain a copy of any investigative consumer report upon request from AmericanChecked Inc., 0000 Xxxxx Xxxxx Xxx. Ste. 120, Tulsa OK 74105, telephone 000-000-0000. New Jersey applicants/employees only: The precise nature and scope of any investigative consumer report will be the same as described in Background Check Disclosure. You have a right to obtain a copy of any investigative consumer report upon request from AmericanChecked, Inc. 0000 Xxxxx Xxxxx Xxx., Ste. 120, Tulsa OK 74105, telephone 000-000-0000. For Oregon applicants/employees only: If the Company obtains information bearing on your credit worthiness, credit standing or credit capacity, it will be because the information is substantially related to the job for which you are being considered/are currently occupying and to evaluate whether you would present an unacceptable risk of theft or other dishonest behavior in the job for which you are being considered/are currently occupying. For Washington State applicants/employees only: You have the right, upon written request made within a reasonable period of time after your receipt of this disclosure, to receive from the Company a complete and accurate disclosure of the nature and scope of any “investigative” consumer report we may have requested. You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act. Any requests under this paragraph should be made to: AmericanChecked Inc., 0000 Xxxxx Xxxxx Xxx., Ste. 120, Tulsa OK 74105, telephone 000-000-0000. If the Company obtains information bearing on your credit worthiness, credit standing or credit capacity, it will be used to evaluate whether you would present an unacceptable risk of theft or other dishonest behavior in the job for which you are being considered.