AUTHORIZATION FORM FOR CONSUMER REPORTS (for New P-Card Holders)
Order Number:___________
HR Use Only
In connection with my application for employment (including contract for services), I understand
that consumer reports or investigative consumer reports which may contain public record
information may be requested or made on me including consumer credit and criminal records.
Further, I understand that information from various Federal, State, local and other agencies which
contain my past activities will be requested.
By signing below, I hereby authorize, without reservation, any party or agency contacted by this
employer to furnish the above mentioned information. I further authorize ongoing procurement
of the above mentioned reports at any time during my employment (or contract). I also agree that
a fax or photocopy of this authorization with my signature can be accepted with the same
authority as the original.
Print your name ___________________________________________________________
Current Address ___________________________________________________________
City____________________ County _________________ State______ ZIP___________
Date First Resided at this Address
(Month & Year) _________________________________________
Social Security Number__________________________
Drivers License State ___________ License number_______________________________
For identification purposes
Date of Birth: Month______ Day_______ Year ________ Race______ Gender: □M □F
Other or former names_______________________________________________________
Signature______________________________________________ Date _______________
Previous Addresses in last 7 years
Must Include County and Dates (Month & Year)
1.___________________________________________________________________________
Street Address, City, County, State, Zip F
rom: To:
2._____________________________________________________________________________
Street Address, City, County, State, Zip F
rom: To:
3._____________________________________________________________________________
Street Address, City, County, State, Zip F
rom: To:
