ADDITIONAL DISCLOSURES & BACKGROUND CHECK AUTHORIZATION
Additional Disclosures
The state disclosures below are included because state law requires them to be provided in
writing. Some of the below rights, notices, or information also may apply to individuals from,
applying to, or volunteering in states not listed below. There may be additional requirements,
options, or provisions applicable to you and you may have additional rights under
applicable law that are not required to be disclosed to you in writing.
Minnesota: You have the right to request a complete and accurate disclosure of the nature and scope
of any consumer report from First Advantage, P.O. Box 105292, Atlanta, GA 30348, 800-845-6004.
New York: Boy Scouts of America and/or its subsidiaries, affiliates, other related entities, and/or
successors (the “Company”) may request or utilize subsequent consumer reports (other than
investigative consumer reports) on you throughout your volunteer relationship with Company. Upon
request, you will be informed whether or not a consumer report was requested, and if such report was
requested, informed of the name and address of the CRA that furnished the report. Your written
request should be made to Company at Boy Scouts of America, Membership Standards Team S201,
1325 West Walnut Hill Lane, P.O. Box 152079, Irving Texas 75015-2079. You may also contact the
Company by email at MembershipStandards@scouting.org
AUTHORIZATION
(Please print)
Name: First ____________________ Middle _______________
Last ________________________ Suffix _________
List any other names used (nickname, maiden/married last names: _________________________________________
Date of Birth: _______________________________
Unit Type and Number: _______________________________
To the extent permitted by applicable law, I hereby consent to and authorize the Boy Scouts of
America and/or its subsidiaries, affiliates, other related entities, and/or successors (the “Company”)
to procure consumer report(s) (as defined by federal law) and/or investigative consumer report(s) (as
defined by applicable California state law), which in my case means criminal background
check(s)/driving record(s), on my background from a consumer reporting agency (“CRA”) or from an
investigative consumer reporting agency (“ICRA”), as described in the Background Check
Disclosure and the California State Law Disclosures (Non-Credit) (each of which I have
received separately from the Company), as well as these Additional Disclosures & Background
Check Authorization. This authorization applies only to criminal checks/driving records and does
not allow the Company to obtain credit checks. I have reviewed and understand the information,
statements, and notices in the Background Check Disclosure and the California State Law
Disclosures (Non-Credit), as well as these Additional Disclosures & Background Check
Authorization. My authorization remains valid throughout my volunteer relationship with the
Company, such that, to the extent permitted by applicable law, I agree Company can procure
additional consumer report(s), which in my case means criminal background check(s)/driving
record(s), during my volunteer relationship without providing additional disclosures or obtaining
additional authorizations. Except as otherwise prohibited by applicable law, I consent to and
authorize the Company to share this information with Company’s local councils and/or chartered
organizations for business reasons (e.g., to place me in certain positions, work sites, etc.). I
understand that, if I am selected for a volunteer position, a consumer report will have been
conducted on me.
For California, Minnesota, or Oklahoma individuals: If you would like to receive from the
CRA, the ICRA, or the Company (as applicable) a copy of the report that Company may procure, please
check this box.
Signature _______________________________________ Date ________________________________________
ADDITIONAL DISCLOSURES & BACKGROUND CHECK AUTHORIZATION
Additional Disclosures
The state disclosures below are included because state law requires them to be provided in
writing. Some of the below rights, notices, or information also may apply to individuals from,
applying to, or volunteering in states not listed below. There may be additional requirements,
options, or provisions applicable to you and you may have additional rights under
applicable law that are not required to be disclosed to you in writing.
Minnesota: You have the right to request a complete and accurate disclosure of the nature and scope
of any consumer report from First Advantage, P.O. Box 105292, Atlanta, GA 30348, 800-845-6004.
New York: Boy Scouts of America and/or its subsidiaries, affiliates, other related entities, and/or
successors (the “Company”) may request or utilize subsequent consumer reports (other than
investigative consumer reports) on you throughout your volunteer relationship with Company. Upon
request, you will be informed whether or not a consumer report was requested, and if such report was
requested, informed of the name and address of the CRA that furnished the report. Your written
request should be made to Company at Boy Scouts of America, Membership Standards Team S201,
1325 West Walnut Hill Lane, P.O. Box 152079, Irving Texas 75015-2079. You may also contact the
Company by email at MembershipStandards@scouting.org
AUTHORIZATION
(Please print)
Name: First ____________________ Middle _______________
Last ________________________ Suffix _________
List any other names used (nickname, maiden/married last names: _________________________________________
Date of Birth: _______________________________
Unit Type and Number: _______________________________
To the extent permitted by applicable law, I hereby consent to and authorize the Boy Scouts of
America and/or its subsidiaries, affiliates, other related entities, and/or successors (the “Company”)
to procure consumer report(s) (as defined by federal law) and/or investigative consumer report(s) (as
defined by applicable California state law), which in my case means criminal background
check(s)/driving record(s), on my background from a consumer reporting agency (“CRA”) or from an
investigative consumer reporting agency (“ICRA”), as described in the Background Check
Disclosure and the California State Law Disclosures (Non-Credit) (each of which I have
received separately from the Company), as well as these Additional Disclosures & Background
Check Authorization. This authorization applies only to criminal checks/driving records and does
not allow the Company to obtain credit checks. I have reviewed and understand the information,
statements, and notices in the Background Check Disclosure and the California State Law
Disclosures (Non-Credit), as well as these Additional Disclosures & Background Check
Authorization. My authorization remains valid throughout my volunteer relationship with the
Company, such that, to the extent permitted by applicable law, I agree Company can procure
additional consumer report(s), which in my case means criminal background check(s)/driving
record(s), during my volunteer relationship without providing additional disclosures or obtaining
additional authorizations. Except as otherwise prohibited by applicable law, I consent to and
authorize the Company to share this information with Company’s local councils and/or chartered
organizations for business reasons (e.g., to place me in certain positions, work sites, etc.). I
understand that, if I am selected for a volunteer position, a consumer report will have been
conducted on me.
For California, Minnesota, or Oklahoma individuals: If you would like to receive from the
CRA, the ICRA, or the Company (as applicable) a copy of the report that Company may procure, please
check this box.
Signature _______________________________________ Date ________________________________________
.
:
02/2020
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