CONSUMER CREDIT and BACKGROUND REPORT RELEASE FORM
PLEASE READ CAREFULLY
BY MY SIGNATURE BELOW I AUTHORIZE
____________________________________
to obtain a Consumer Credit Report and/or a Background Report on me. This
authorization is valid for purposes of verifying information given pursuant to
employment, leasing, rental, business negotiations, or any other lawful purpose covered
under the Fair Credit Reporting Act. (FCRA)
The Background Check may contain information available in the Public Domain but may
not include interviews with persons other than previous employers or their agents.
By my signature below, I hereby authorize all corporations, former employers, credit
agencies, educational institutions, law enforcement agencies, city, state, county and
federal courts and agencies, military services and persons to release all information they
may have about me including criminal and driving history. This authorization shall be
valid in original or copy form.
Applicant's Name _____________________________________________________
Social Security Number ________________________________________________
Date of Birth ________________________________________________________
Current Street Address ________________________________________________
City, State, Zip Code _________________________________________________
Drivers License # _______________________ State ______________
Signature ______________________________
Date ___________________________________
**NOTE: PLEASE INCLUDE A COPY OF A VALID DRIVERS LICENSE**