Applicant Consent Form for Pre-Employment or Tenant Screening Investigation & Specific Release

Please Print and Have Signed

I certify and declare under penalty of perjury under relevant state and federal law that the information contained in my employment/leasing application is complete, true, and accurate. I acknowledge that falsification or omission of information may result in immediate dismissal or retraction of any offer of employment/lease.

In consideration of_____________________________ís (herein referred to as EMPLOYER/LANDLORD) review of my application for employment/leasing, I hereby voluntarily consent to and authorize EMPLOYER/LANDLORD, or its authorized agents bearing this release or copy thereof, to obtain a consumer report for employment/leasing purposes. I agree that this consumer report may include any of the following:

I authorize all persons and organizations that may have information relevant to this research to disclose such information to EMPLOYER/LANDLORD or its authorized agents. I hereby release EMPLOYER/LANDLORD, its authorized agents, and all persons and organizations providing information from all claims and liabilities of any nature in connection with this research. I hereby further authorize that a photocopy of this authorization may be considered as valid as the original.

I understand that I have specific prescribed rights as a consumer under the federal Fair Credit Reporting Act ('FCRA') and may have additional rights under relevant state law. I hereby certify that I have been presented with a summary of my rights as a consumer under the Fair Credit Reporting Act.

_____________________________________________

_________

Signature of Applicant

Date

______________________________________________
Printed Name

____________________________________Date of birth

____________________________________Social Security number

____________________________________Drivers license number # and State of issue


© 1999-2002, CSI Background Checks : Bishops Corner, CT 06137-0156
All Rights Reserved. All Unauthorized Duplication Prohibited. Rev. 10/29/07