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    Background Check Consent Form

    Uploaded by

    api-235389680

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Background Check Consent Form

    Uploaded by

    api-235389680
    139 views1 page

    Original Title

    background check consent form

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    © © All Rights Reserved

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    Copyright:

    © All Rights Reserved
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    139 views1 page

    Background Check Consent Form

    Uploaded by

    api-235389680

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    DISCLOSURE AND AUTHORZATION

    ItMpoRTANT
    _ pLEASE
    READ CAREFULLy EEFORE StcNtNG AUTHORTZATtONI
    qLSElgst
    JgE REGARllllc BAcKGROUIIQ
    It\!\/ESTLGAItON
    Gardner-webb
    university (lhe company') may obtain information
    about you from a consumer reporting
    agency for enrollment or continued enrollment purposes.
    Thus, you
    may be the subject of a "consumer-
    report" and/or an 'invesligative
    consumer report'which may inciude information
    about your
    character,
    general
    reputation, personal
    characteristics, and/or mode ol living. These reports may iontain information
    regarding your credit history, criminal history, social secunty 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 thiJnotice, to request dtsclosure of
    the nature and scope of any investigative consumer report. The scope of this notice and authorization is alt-
    encompassing, however, allowing Gardner-webb university to obtain from any outside organization
    all
    manner of consumer reports and investigative consumer reporls now and throughout the iourse of your
    enrollment to lhe extent permitted
    by law. As a result, you
    should carefully consider whether to exercise
    y0ur right to request disclosure of the nature and scope of any investigative consumer reporr.
    AQ{X9WLEDGMENT
    AND AUTHORIZATION
    I acknowledge receipt of he DtsclosuRE REGARDING BACKGRouND
    tNVESTtGAT|oN
    and cerrify
    that I have read and understand this document. I hereby authorize the obtaining of
    -conruret.
    t..portr;
    '
    and/or.'invesligative
    consumer reports' by the Company at any time after receipt of this authorization and
    hroughout my employment, if applicable. To this end, I herebf authorize, without reservation,
    any taw
    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 Background
    Data, rnc.,50 Jasmine court, Newnan, GA 3'0265, fill -nz-oilq,
    another outside organization acting on behalf of Gardner-Webb University, and/or Gardner-Webb
    University
    itself l agree that a facsimile ('fax"),
    electronic or photographic
    copy of this Authorizatjon
    shall be as valid as
    the original.
    Last Name
    First
    Middle
    Other Names/Alias
    Social Security'#
    Dnver's License #
    Present Address
    Date of Birth'
    State of Driver's License
    Phone Number
    City/State/Zip
    Signature;
    Date:

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