C I T Y O F D E C A T U R
Notice of Disclosure & Consumer Consent
(Related to Fair Credit Reporting Act)
Consumer Information (Applicant/Employee/Volunteer/Vendor/Solicitor)
The information you provide below will be used solely for the purpose of obtaining consumer reports for employment or business-related purpos-
es. The City of Decatur will not use this information for any reason that violates applicable Federal or State equal employment opportunity laws or
Legal Name: Social Security #: Date/Birth:
Home Address: City: ST: ZIP:
Driver’s License: Type: Operator Commercial Other Class: A B C Other State/Issue:
Status: o Applicant applying for new position. Name of Position:
o Current employee applying for new position. Name of New Position:
o Volunteer applying for position. Hosting Dept: Name of Position:
o Other Employment or Business-Related Activity. Description:
In compliance with the Fair Credit Reporting Act (FCRA), the City of Decatur is notifying you as a consumer that in-
formation provided by you on the City’s employment applications or other similar documents may be verified using
“consumer reports” provided by a “consumer reporting agency” (CRA) for employment purposes or other legitimate
business-related purposes. The City of Decatur has contracted with a number of CRA’s to verify certain information
provided by you for employment or business-related purposes. Under FCRA, “employment purposes” means a re-
port used for evaluating a consumer for employment, promotion, reassignment, or retention as an employee.
“Business-related purposes” includes volunteer applicants, vendors/solicitors, license/permit applicants, or others
performing business-related services related to the City.
As defined in FCRA 603 (d) (1) (A), “consumer reports” include, but are not limited to, written communications from
CRA’s reflecting an applicant’s financial position, character, general reputation, personal characteristics or mode of
living for employment purposes. Examples of “consumer reports” that the City may use include, but are not limited
to verifications and/or information on the following: motor vehicle records, criminal and civil records, credit reports,
education records, prior employment, and other public documents.
Your employment, continued employment, or affiliation with the City of Decatur may be determined in whole or in
part by the City using data from consumer reports supplied by various CRA’s. Pursuant to Section 609 of the FCRA,
you may be entitled to a copy of the consumer reports provided by the CRA.
In compliance with the FCRA, the City of Decatur agrees information obtained through CRA’s will not be used in vio-
lation of any applicable Federal or State equal employment opportunity law or regulation.
Consumer Acknowledgement and Consent
I understand and agree that one or more consumer reporting agencies will verify all or part of the information I have
given the City of Decatur in employment applications, telephone conversations, interviews, or by other means during
the application process for employment, volunteer opportunities, licenses/permits, or other similar legitimate busi-
ness-related activities. I understand that this verification may include an inquiry into my credit history, motor vehicle
driving records, criminal and civil records, prior employment (including contacting prior employers), education
(degree, GPA and attendance) as well as other public record information.
I release and hold harmless from all liability any individual or entity, including the City of Decatur and the CRA’s it
uses, for requesting or supplying information with respect to my application for employment or other legitimate busi-
ness-related purpose. If employed or accepted by the City, I understand that this document will remain valid
throughout my employment and/or affiliation with the City. I agree that this document constitutes proper, legal notice
of FCRA disclosures and authorizes my consent to perform checks related to my employment or business affiliation
with the City.
I authorize and consent to the release of such information as may be necessary to verify the information I
have provided. I am also aware, and do further consent and authorize the City of Decatur to use this infor-
mation to evaluate my candidacy for employment, my continued employment, or my affiliation with the City
Printed/Typed Name of Consumer Signature of Consumer Date
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