The City of Glenn Heights Consumer Report Disclosure Form
The City of Glenn Heights may, with your consent, obtain a consumer report (as defined by the Fair Credit Reporting Act),
related to your prospective, current, or future employment. This may include procurement of an investigative consumer
report (defined as a report that includes
information as to your character, general reputation, personal characteristics, or
mode of living).
You may request that the nature and scope of any investigative consumer report be disclosed to you. Such disclosure will be
made within 5 days of our receipt of the request from you or five days after the date the investigative consumer report
was
first requested, whichever is later.
By signing below, you grant permission to The City of Glenn Heights or any of its affiliated or subsequent companies to
obtain such report or reports at any time. You also grant permission to all parties to release information regarding your
previous or current military service, employment, education, or criminal matters,
including information which may be
deemed negative.
____________________________________ ____________
Signature Date
Identity Information
First Name:
Middle Name:
Last Name:
Current Address:
City: State: Zip:
Other Names Used (Maiden or Aliases):
Social Security Number:
Driver’s License Number: State:
Date of Birth: Month: Day: Year:
Please list each city/county and state in which you have lived, worked, or attended school during the last ten (10)
years. Use the back of this form if necessary to provide full disclosure.
City: County: State:
City: County: State:
City: County: State:
City: County: State:
City: County: State:
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signature
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