Disclosure and Authorization
to Obtain Consumer Reports for Employment/Volunteer Purposes
Please Read Carefully!
In considering you for a volunteer position or employment and, if you are employed, in considering you for subsequent promotion, assignment, reassignment, retention, or discipline, Girl Scouts of Western New York, Inc. (the Company”) may request and rely upon one or more consumer reports or investigative consumer reports about you that we obtain from a consumer reporting agency, such as IntelliCorp Records, Inc.
For explanation purposes:
- a “consumer report” is a written, oral or other communication of any information by a consumer reporting agency bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in making an employment-related decision about you. Such information may include, for example, credit information, reports from government sources, criminal history reports, or driving records; and
- an “investigative consumer report” is a consumer report in which information on your character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with your prior employers, neighbors, friends, or associates, or with others who may have knowledge concerning any such items of information. In the event an investigative consumer report is requested about you, you are entitled to additional disclosures regarding the nature and scope of the investigation requested, as well as a written summary of your rights under the Fair Credit Reporting Act (“FCRA”).
Under the FCRA, before the Company can obtain a consumer report or investigative consumer report about you for employment purposes, we must have your authorization. Before we take adverse action on the basis, in whole or in part, of information in that report, you will be provided a copy of that report, the name, address, and telephone number of the consumer reporting agency, and a summary of your rights under the FCRA.
Girl Scouts of Western New York, Inc. Report Details
Social Security Number Verification/Address History, Nationwide Sex Offender Registry, Multi-State Criminal Search
I have carefully read the Disclosure and Authorization and authorize the Company to obtain and rely upon one or more consumer reports and investigatory consumer reports. I also agree that this Disclosure and Authorization in original, faxed, photocopied, or electronic (including electronically signed by clicking the authorization button below) will be valid for any consumer reports or investigative consumer reports that may be requested about me by or on behalf of the Company.
I certify that all of elements of the personal data I will provide in this portal are true, accurate and complete. I understand and agree that any omission, false statement, misleading statement, or answer made by me on my information or any supplements to it and in any interviews will be sufficient grounds for rejection of employment and my discharge after employment. I also understand that nothing in the Disclosure and Authorization shall be construed as an offer of employment or contract for services.
You have the right, upon written request made within a reasonable amount of time, to request whether a consumer reports has been run about you and disclosure of the nature and scope of any investigative consumer report and to request a copy of your report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment is an investigation into education and/or employment history conducted by IntelliCorp Records, Inc. [3000 Auburn Drive, Suite 410; Beachwood, Ohio 44122; 1-866-202-1436]. The scope of this notice and authorization is all encompassing, however, allowing the Company to obtain from any outside organization all manner of consumer reports throughout the course of your employment to the extent permitted by law.
I understand the use of my Social Security number on the criminal Background Check shall be used for no other purpose than to conduct a Background Check. Furthermore, I understand that my Social Security number shall not be sold or in any way transferred to a third party except for the express purpose of conducting the Background Check.
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