Fillable DISCLOSURE AND AUTHORIZATION (Montreat College)

Fill Online, Printable, Fillable, Blank DISCLOSURE AND AUTHORIZATION (Montreat College) Form

Use Fill to complete blank online MONTREAT COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

DISCLOSURE AND AUTHORIZATION (Montreat College)

On average this form takes 17 minutes to complete

The DISCLOSURE AND AUTHORIZATION (Montreat College) form is 3 pages long and contains:

0 signatures
5 check-boxes
65 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Montreat College

BROWSE MONTREAT COLLEGE FORMS

Related forms

Fill has a huge library of thousands of forms all set up to be filled in easily and signed.

Fill in your chosen form

Sign the form using our drawing tool

Send to someone else to fill in and sign.

find another form

DISCLOSURE AND AUTHORIZATION

[IMPORTANT -- PLEASE READ CAREFULLY

BEFORE SIGNING AUTHORIZATION]

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

ORDER NUMBER:

FAX: 910.343.9731

Company Name: CAC:

(“the Company”) may obtain information

about you for employment purposes from a third party consumer reporting agency. Thus, you may be the subject of a “consumer report” and/or an “investigative

consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve

personal interviews with sources such as your neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal

history, social security verification, motor vehicle records (“driving records”), verification of your education or employment history, or other background checks.

You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative

consumer report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for

employment is an investigation into your education and/or employment history conducted by Castle Branch, Inc., 1845 Sir Tyler Drive, Wilmington, NC 28405,

888-723-4263, or another outside organization. The scope of this notice and authorization is all-encompassing, however, allowing the Company to obtain from any

outside organization all manner of consumer reports and investigative consumer reports now and throughout the course of your employment to the extent permitted by

law. As a results, you should carefully consider whether to excercise your right to request disclosure of the nature and scope of any investigative consumer report.

New York and Maine applicants or employees only: You have the right to inspect and receive a copy of any investigative consumer report

requested by the Company by contacting the consumer reporting agency identified above directly. You may also contact the Company to

request the name, address, and telephone number of the nearest unit of the consumer reporting agency designated to handle inquiries, which

the Company shall provide within 5 days.

New York applicants or employees only: Upon request, you will be informed whether or not a consumer report was requested by the Company,

and if such report was requested, informed of the name and address of the consumer reporting agency that furnished the report. By signing

below, you also acknowledge receipt of Article 23-A of the New York Correction Law.

Oregon applicants or employees only: Information describing your rights under federal and Oregon law regarding consumer identity theft

protection, the storage and disposal of your credit information, and remedies available to you should you suspect or find that the Company has

not maintained secured records is available to you upon request.

Washington State applicants or employees only: 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.

ACKNOWLEDGEMENT AND AUTHORIZATION

I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT

REPORTING ACT and certify that I have read and understand both of those documents. 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 my employment, if applicable. To this end, I hereby authorize,

without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service

bureau, employer, or insurance company to furnish any and all background information requested by Castle Branch, Inc., 1845 Sir Tyler Drive, Wilmington, NC

28405, 888-723-4263, another outside organization acting on behalf of the Company, and/or the Company itself. I agree that a facsimile (“fax”), electronic or

photographic copy of this Authorization shall be as valid as the original.

New York applicants or employees only: By signing below, you also acknowledge receipt of Article 23-A of the New York Correction Law.

Minnesota and Oklahoma applicants or employees only: Please check this box if you would like to receive a copy of a consumer report if one is

obtained by the Company.

California applicants or employees only: By signing below, you also acknowledge receipt of the NOTICE REGARDING BACKGROUND

INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check this box if you would like to receive a copy of an investigative consumer

report or consumer credit report at no charge if one is obtained by the Company whenever you have a right to receive such a copy under Cali-

fornia law.

Last Name First Middle

Other Names/Maiden/Alias

Social Security*# Date of Birth* (mo/day/year)

Driver’s License# State

Phone#

Present Address

City State Zip

County

*This information will be used for background screening purposes only and will not be used as hiring criteria.

[Note: If you do business in Utah, you cannot ask for DOB, driver’s license, or SSN until either a confidential offer of employment or at the time

the background report will be run.]

Applicant Signature: Date:

For Employer Use Only: Please mark (4) the searches to be conducted.

Contact: Email:

Phone: Fax:

NOTICE REGARDING BACKGROUND INVESTIGATION

PURSUANT TO CALIFORNIA LAW

(“the Company”)

intends to obtain information about you for employment purposes from a consumer reporting agency. Thus, you can expect to be

the subject of “investigative consumer reports” and “consumer credit reports” obtained for employment purposes. Such reports

may include information about your character, general reputation, personal characteristics and mode of living. With respect to any

investigative consumer report from an investigative consumer reporting agency (“ICRA”), you, including but not limited to obtaining

a criminal record report, verifying references, work history, your social security number, your educational achievements, licensure,

and certifications, your driving record, and other information about you, and interviewing people who are knowledgeable about

you. The results of this report may be used as a factor in making employment decisions. The source of any investigative consumer

report (as that term is defined under California law) will be Castle Branch, Inc., 1845 Sir Tyler Drive, Wilmington, NC 28405,

888-723-4263. The source of any credit report will be Castle Branch, Inc., 1845 Sir Tyler Drive, Wilmington, NC 28405,

888-723-4263. The Company agrees to provide you with a copy of an investigative consumer report when required to do so under

California law.

Under California Civil Code section 1786.22, you are entitled to find out from an ICRA what is in the ICRA’s file on you with proper

identification, as follows:

                    • In person, by visual inspection of your file during normal business hours and on reasonable notice. You also may request a

copy of the information in person. The ICRA may not charge you more than the actual copying costs for providing you with

a copy of your file.

                     • A summary of all information contained in the ICRA’s file on you that is required to be provided by the California Civil

Code will be provided to you via telephone, if you have made a written request, with proper identification, for telephone

disclosure, and the toll charge, if any, for the telephone call is prepaid by or charged directly to you.

                   • By requesting a copy be sent to a specified addressee by certified mail. ICRAs complying with requests for certified mailing

shall not be liable for disclosures to third parties caused by mishandling of mail after such mailings leave the ICRAs.

“Proper Identification” includes documents such as a valid driver’s license, social security account number, military identification

card, and credit cards. Only if you cannot identify yourself with such information may the ICRA require additional information

concerning your employment and personal or family history in order to verify your identify

The ICRA will provide trained personnel to explain any information furnished to you and will provide a written explanation of any

coded information contained in files maintained on you. This written explanation will be provided whenever a file is provided to you

for visual inspection.

You may be accompanied by one other person of your choosing, who must furnish reasonable identification. An ICRA may require

you to furnish a written statement granting permission to the ICRA to discuss your file in such person’s presence.

Notice Regarding Credit Checks:

Pursuant to Section 1024.5 of the California Labor Code, the Company informs you that it may obtain a credit report about you

from the above named entity, because you are seeking to work in the following position:

An employee covered by the executive exemption set forth in subparagraph (1) of paragraph (A) of Section 1 of Wage

Order 4 of the Industrial Welfare Commission;

A position in the state Department of Justice;

A sworn peace officer or other law enforcement;

A position for which the information contained in the report is required by law to be disclosed or obtained;

A position that involves regular access to specified personal information for any purpose other than the routine

solicitation and processing of credit card applications in a retail establishment, such as bank or credit card account

information, social security number, or date of birth;

A position which the person can enter into financial transactions on behalf of the Company;

A position that involves access to confidential or proprietary information;

A position that involves regular access to $10,000 or more of cash; OR

The Company will not obtain a consumer credit report on you.

The Company is subject to 15 U.S.C. Sec. 6801-6809, the Gramm-Leach-Bliley Act and Section 1024.5 of the

California Labor Code does not apply.

NOTICE REGARDING CREDIT CHECKS PER VERMONT LAW

Pursuant to Vermont Act No. 154 (S. 95), the Company informs you that it may obtain a credit report about you, for the

following reason(s):

The information is required by state or federal law or regulation;

You seek to be/are employed in a position that involves access to “confidential financial information” (defined as

“sensitive financial information of commercial value that a customer or client of the employer gives explicit authorization

for the employer to obtain, process, and store and that the employer entrusts only to managers or employees as a

necessary function of their job duties”);

The Company is a financial institution as defined in 8 V.S.A. §11101(32) or a credit union as defined in 8 V.S.A.

§30101(5);

You seek to be/are employed in a position as a law enforcement officer, emergency medical personnel or firefighter as

these terms are respectively defines in 20 V.S.A. §2358, 24 V.S.A. §2651(6) and 20 V.S.A. §3151(3)

You seek to be/are employed in a position that requires a financial fiduciary responsibility to the Company or a Company’s

clients, including the authority to issue payments, collect debts, transfer money or enter into contracts;

You seek to be/are employed in a position that involves access to the Company’s payroll information;

The Company can demonstrate that credit information is a valid and reliable predictor of employee performance in the

your specific position of employment;

The Company will not obtain a consumer credit report on you.

Para informacion en espanol, visite www.consumerfinance.gov/learnmore o escribe a la

Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20006.

A Summary of Your Rights Under the Fair Credit Reporting Act

The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and

privacy of information in the files of consumer reporting agencies. There are many types of

consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies

that sell information about check writing histories, medical records, and rental history records).

Here is a summary of your major rights under the FCRA. For more information, including

information about additional rights, go to www.consumerfinance.gov/learnmore or write

to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20006.

You may have additional rights under Maine’s FCRA, Me. Rev. Stat. Ann. 10, Sec 1311 et

seq.

• You must be told if information in your file has been used against you. Anyone who

uses a credit report or another type of consumer report to deny your application for credit,

insurance, or employment – or to take another adverse action against you – must tell you,

and must give you the name, address, and phone number of the agency that provided the

information.

• You have the right to know what is in your file. You may request and obtain all the

information about you in the files of a consumer reporting agency (your “file

disclosure”). You will be required to provide proper identification, which may include

your Social Security number. In many cases, the disclosure will be free. You are entitled

to a free file disclosure if:

• a person has taken adverse action against you because of information in your credit

report;

• you are the victim of identify theft and place a fraud alert in your file;

• your file contains inaccurate information as a result of fraud;

• you are on public assistance;

• you are unemployed but expect to apply for employment within 60 days.

In addition, all consumers are entitled to one free disclosure every 12 months upon

request from each nationwide credit bureau and from nationwide specialty consumer

reporting agencies. See www.consumerfinance.gov/learnmore for additional

information.

• You have the right to ask for a credit score. Credit scores are numerical summaries of

your credit-worthiness based on information from credit bureaus. You may request a

credit score from consumer reporting agencies that create scores or distribute scores used

in residential real property loans, but you will have to pay for it. In some mortgage

transactions, you will receive credit score information for free from the mortgage lender.

• You have the right to dispute incomplete or inaccurate information. If you identify

information in your file that is incomplete or inaccurate, and report it to the consumer

reporting agency, the agency must investigate unless your dispute is frivolous. See

www.consumerfinance.gov/learnmore for an explanation of dispute procedures.

• Consumer reporting agencies must correct or delete inaccurate, incomplete, or

unverifiable information. Inaccurate, incomplete or unverifiable information must be

removed or corrected, usually within 30 days. However, a consumer reporting agency

may continue to report information it has verified as accurate.

• Consumer reporting agencies may not report outdated negative information. In

most cases, a consumer reporting agency may not report negative information that is

more than seven years old, or bankruptcies that are more than 10 years old.

• Access to your file is limited. A consumer reporting agency may provide information

about you only to people with a valid need – usually to consider an application with a

creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a

valid need for access.

• You must give your consent for reports to be provided to employers. A consumer

reporting agency may not give out information about you to your employer, or a potential

employer, without your written consent given to the employer. Written consent generally

is not required in the trucking industry. For more information, go to

www.consumerfinance.gov/learnmore.

• You may limit “prescreened” offers of credit and insurance you get based on

information in your credit report. Unsolicited “prescreened” offers for credit and

insurance must include a toll-free phone number you can call if you choose to remove

your name and address from the lists these offers are based on. You may opt-out with the

nationwide credit bureaus at 1-888-567-8688.

• You may seek damages from violators. If a consumer reporting agency, or, in some

cases, a user of consumer reports or a furnisher of information to a consumer reporting

agency violates the FCRA, you may be able to sue in state or federal court.

• Identity theft victims and active duty military personnel have additional rights. For

more information, visit www.consumerfinance.gov/learnmore.

States may enforce the FCRA, and many states have their own consumer reporting laws. In some

cases, you may have more rights under state law. For more information, contact your state or local

consumer protection agency or your state Attorney General. For information about your federal

rights, contact:

TYPE OF BUSINESS:

CONTACT:

1.a. Banks, savings associations, and credit unions with total assets of over $10 billion and their

affiliates.

b. Such affiliates that are not banks, savings associations, or credit unions also should list, in

addition to the Bureau:

a. Bureau of Consumer Financial Protection

1700 G Street NW

Washington, DC 20006

b. Federal Trade Commission: Consumer Response Center –

FCRA

Washington, DC 20580

(877) 382-4357

2. To the extent not included in item 1 above:

a. National banks, federal savings associations, and federal branches and federal agencies of

foreign banks

b. State member banks, branches and agencies of foreign banks (other than federal branches,

federal agencies, and insured state branches of foreign banks), commercial lending companies

owned or controlled by foreign banks, and organizations operating under section 25 or 25A of

the Federal Reserve Act

c. Nonmember Insured Banks, Insured State Branches of Foreign Banks, and insured state

savings associations

d. Federal Credit Unions

a. Office of the Comptroller of the Currency

Customer Assistance Group

1301 McKinney Street, Suite 3450

Houston, TX 77010-9050

b. Federal Reserve Consumer Help Center

P.O. Box 1200

Minneapolis, MN 55480

c. FDIC Consumer Response Center

1100 Walnut Street, Box #11

Kansas City, MO 64106

d. National Credit Union Administration

Office of Consumer Protection (OCP)

Division of Consumer Compliance and Outreach (DCCO)

1775 Duke Street

Alexandria, VA 22314

3. Air carriers

Asst. General Counsel for Aviation Enforcement & Proceedings

Department of Transportation

400 Seventh Street SW

Washington, DC 20590

4. Creditors Subject to Surface Transportation Board

Office of Proceedings, Surface Transportation Board

Department of Transportation

1925 K Street NW

Washington, DC 20423

5. Creditors Subject to Packers and Stockyards Act

Nearest Packers and Stockyards Administration area supervisor

6. Small Business Investment Companies

Associate Deputy Administrator for Capital Access

United States Small Business Administration

406 Third Street, SW, 8th Floor

Washington, DC 20416

7. Brokers and Dealers

Securities and Exchange Commission

100 F St NE

Washington, DC 20549

8. Federal Land Banks, Federal Land Bank Associations, Federal Intermediate Credit Banks,

and Production Credit Associations

Farm Credit Administration

1501 Farm Credit Drive

McLean, VA 22102-5090

9. Retailers, Finance Companies, and All Other Creditors Not Listed Above

FTC Regional Office for region in which the creditor operates or

Federal Trade Commission: Consumer Response Center – FCRA

Washington, DC 20580

(877) 382-4357

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

DISCLOSURE AND AUTHORIZATION (Montreat College)

View Audit Log
Print With Audit Log
Duplicate Document

Fillable DISCLOSURE AND AUTHORIZATION (Montreat College)

Fill Online, Printable, Fillable, Blank DISCLOSURE AND AUTHORIZATION (Montreat College) Form

Related forms

First 20 documents completely FREE!