I authorize Redlands Community College (the Company”) to obtain a consumer report(s) (or background report(s)) on
me, including any
investigative consumer reports. I also agree that a copy of this form is valid like the signed original.
A consumer reporting agency (CRA) will prepare the background report for the Company. The Company will use one of the
following companies to prepare the background report:
U.S. Information Search ADP Screening and Selection Services, Inc.
615 South College Street 301 Remington Street
Charlotte, NC 28202 Fort Collins, CO 80524
(800) 596-4327 (800) 367-5933
I understand that, as allowed by applicable law, the Company may rely on this authorization to order additional background
reports, including
investigative consumer reports, (1) during my employment or time as a volunteer or independent
contractor, as applicable and (2) from any CRA other than the two listed above without asking me for my authorization
again. I understand the Company may order background report(s) under my legal name and any other names I may have
I also authorize the following persons, agencies, and entities to disclose to any CRA listed above and its agents all information
about or concerning me, as allowed by law, including but not limited to: my past or present employers; learning institutions,
including colleges and universities; law enforcement and all other federal, state and local agencies; federal, state and local
courts; the military; credit bureaus; testing facilities; motor vehicle records agencies; if applicable, worker’s compensation
injuries; all other private and public sector repositories of information; and any other person, organization, or agency with
any information about or concerning me. As allowed by law, such disclosures may contain the following information
pertaining to you: credit history; public records; a Social Security number verification; driving records; military service;
credentials/certifications; and verification of prior employment and education.
If you live or work for the Company in California, Minnesota or Oklahoma: Check this box if you would like a free copy of
your background check report:
Please print your legal name:
Last Name _______________________First ________________________ Middle ___________________________
______________________________________________________________ _____/_______/________
Signature Date (Month/Day/Year)
click to sign
click to edit
I understand the information requested below is collected solely for the purpose of aiding the Consumer Reporting Agency (CRA) in
completing a background check on me, of which I do authorize.
__________________________ ______________________ ____________________________________ ____________
First Name Middle Name (required) Last Name Suffix
Email Address: _____________________________________________________________________________________
For Identification Purposes Only: Date of Birth ____/____/______ (Month/Day/Year)
Social Security Number ____________________________________________________
Driver’s License Number ______________________________ State Issuing License_________________________
Enter Nickname(s) Used__________________________________________________________________________
Enter Any Other Names Used (including maiden names):
First Name _________________________Middle Name __________________Last Name_________________________
First Name _________________________Middle Name __________________Last Name_________________________
First Name _________________________Middle Name __________________Last Name_________________________
Addresses Within The Past SEVEN (7) Years (use a separate sheet as needed)
Present Street Address ___________________________________________________________
City/State/ZIP ___________________________________________________________________________
Prior Street Address _________________________________________________________________
Prior City/State/ZIP __________________________________________________________________________
From _____/_______/______ (Month/Day/Year) To _____/_______/______ (Month/Day/Year)
Prior Street Address _________________________________________________________________
Prior City/State/ZIP __________________________________________________________________________
From _____/_______/______ (Month/Day/Year) To _____/_______/______ (Month/Day/Year)
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome