CREDIT REPORT AND/OR
INVESTIGATIVE CONSUMER REPORT FOR EMPLOYMENT PURPOSES
CONSENT, AUTHORIZATION, RELEASE AND HOLD HARMLESS
I, desiring to obtain employment with Two Roads Professional Resources, Inc., do hereby consent to and authorize Two Roads Professional Resources, Inc. and/or any representative or affiliate of Moore Information Services, Inc.(MIS) or Mooreinfoinc, to obtain, verify and exchange information on any reports concerning me as are maintained by, but not limited to, the following. Criminal history records from any criminal justice agency in any or all-federal, state, city and county jurisdictions. State Department of Motor Vehicle/Drivers’ License Records to include traffic citations and registration. Military National Personnel Record Center. Educational institutions to include transcripts, any individual, company, firm, corporation, present and/or past employers or public agencies (including the Social Security Administration and the Immigration & Naturalization Service). I understand that Two Roads Professional Resources, Inc. may consider any information obtained, in their sole discretion, as a factor in decisions they make, with respect to the employment for which I am applying. Additionally, I am aware that this report may be provided to Two Roads' clients upon their request.
Furthermore, I hereby release and hold harmless agents, owners and affiliates of Two Roads Professional Resources, Inc. and/or any representative or affiliate of Moore Information Services, Inc.(MIS)or Mooreinfoinc, but not limited to, the following. The officers, directors, and employees of any criminal justice agency in any or all federal, state, city, and county jurisdictions. State Department of Motor Vehicle/Drivers’ License Records, Military National Personnel Record Center and educational institutions, any individual, company, firm, corporation, present and/or past employers or public agencies, (including the Social Security Administration and the Immigration & Naturalization Service), that shall provide information to Two Roads Professional Resources, Inc. and/or representatives of Moore information Services, Inc. (MIS) or Mooreinfoinc, upon request, from and against any and all claims, demands, suits or expenses from or related to the content, validity or handling of said reports.
I agree that a photocopy or telephonic facsimile of this authorization shall be valid as the original.
Signature of ApplicantDate
FAIR CREDIT REPORTING ACT DISCLOSURE
Two Roads Professional Resources, Inc. may wish to obtain a “consumer report” from a “consumer reporting agency” when considering your application for employment.
The terms “consumer,” “consumer reporting agency,” and “consumer report” are defined in the Fair Credit Reporting Act (“FCRA”), which applies to you. Under the FCRA, you are a “consumer.”
A “consumer reporting agency” is a person or business that, for monetary fees, dues, or on a cooperative nonprofit basis, regularly assembles or evaluates consumer credit information or other information on consumers to furnish “consumer reports” to others, such as MIS.
A “consumer report” is any written, oral, or other communication of any information by a “consumer reporting agency” bearing on a consumer’s credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living that is used or collected for the purpose of serving as a factor in establishing the consumer’s eligibility for employment purposes.
If Two Roads Professional Resources, Inc. obtains a “consumer report” about you, and if it considers any information in the report when making an employment-related decision that directly and adversely affects you, you will be provided with a copy of the “consumer report” and a summary of your rights under the FCRA before the decision is finalized. You also may contact the Federal Trade Commission about your rights under the FCRA.
Before Two Roads Professional Resources, Inc. can obtain a “consumer report” about you; you must give your consent in writing.
AUTHORIZATION TO OBTAIN A CONSUMER REPORT
By signing below, I, , acknowledge that I have read the Fair Credit Reporting Act Disclosure. I hereby voluntarily authorize Two Roads Professional Resources, Inc. and/or Moore Information Services, Inc.(MIS) or Mooreinfoinc to obtain a “consumer report” about me from a “consumer reporting agency,” which may include information about my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, and mode of living. I also authorize Two Roads Professional Resources, Inc., to consider the report when making decisions regarding my employment at Two Roads Professional Resources, Inc.. I understand that I have rights under the FCRA, including the rights discussed in the above disclosure.
I wish to receive a copy of any such consumer credit report Moore Information Services, Inc. (MIS) or Mooreinfoinc may obtain regarding my employment application.
I agree that a photocopy or telephonic facsimile of this authorization shall be valid as the original.
Signature of ApplicantDate
TO OBTAIN ACCURATE BACKGROUND INFORMATION,
PLEASE PROVIDE ALL OF THE INFORMATION REQUESTED.
PLEASE PRINT CLEARLY
Applicant's Full Name:
Social Security Number:
Driver's License Number:
State Issued:
Expiration Date:
Other Names Used:
(Under which records
may be listed)
Date of Birth:
Highest Level of Education:
School Name, Location:
Do you admit to any criminal conviction other than minor traffic violations? Yes No
If you answered "Yes", please explain:
In order to expedite the verification of your past employment, please complete this form starting with your most recent employer and going back for five years. Please be sure to list the company that issued your paycheck/W-2 and a contact person that can verify dates of employment.
Dates of Employment:
Company name:
Address:
Contact:Title:Phone #:
Dates of Employment:
Company name:
Address:
Contact:Title:Phone #:
Dates of Employment:
Company name:
Address:
Contact:Title:Phone #:
Dates of Employment:
Company name:
Address:
Contact:Title:Phone #:
Dates of Employment:
Company name:
Address:
Contact:Title:Phone #:
This will be sent to Moore Information Services for verification. You may be contacted directly if additional information is required. If we are unable to verify your previous employer(s), it will be your responsibility to provide proof of employment (W2s or paystubs) within 2 business days of the request.______(Initial)
Signature:Date:
Telephone:
Please return completed forms to Molly Kidder at Two Roads Professional Resources
via email () or confidential FAX line (714-459-7104)