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BACKGROUND FORM

Background Check Disclosure

Your company may request background information about you from a consumer reporting agency in connection with your employment application and for employment purposes.  This information may be obtained in the form of consumer reports and/or investigative consumer reports.  These reports may be obtained at any time after receipt of your authorization and, if you are hired by the Company, throughout your employment. 

 

SonicTest Labs will obtain the reports for the Company. SonicTest Labs Compliance department is located at 1192 E. Draper PKWY #232 Draper, Utah 84020 and can be contacted at 800-883-9621. The reports may contain information bearing on your character, general reputation, personal characteristics, mode of living and credit standing.  The types of information that may be obtained include, but are not limited to: social security number verifications; credit reports; criminal records checks; public court records checks; driving records checks; educational records checks; employment verifications; personal and professional references checks; licensing and certification records checks; drug testing results; etc.  The information contained in the reports will be obtained from private and public record sources, including, as appropriate, personal interviews with sources, such as neighbors, friends, associates and former employers.

 

You may request more information about the nature and scope of any investigative consumer reports by contacting the Company. A summary of your rights under the Fair Credit Reporting Act is also being provided to you. 

ADDITIONAL STATE LAW NOTICES

If you are a California, Maine, New York or Washington applicant, please also note:

 

NEW YORK:  You have the right, upon request, to be informed of whether or not a consumer report was requested.  If a consumer report is requested, you will be provided with the name and

CALIFORNIA: Under section 1786.22 of the California Civil Code, you may view the file maintained on you by Intellishield during normal business hours.  You may also obtain a copy of this file, upon submitting proper identification and paying the costs of duplication services, by appearing at Intellishield offices in person, during normal business hours and on reasonable notice, or by mail.  You may also receive a summary of the file by telephone, upon submitting proper identification.  Intellishield has trained personnel available to explain your file to you, including any coded information.  If you appear in person, you may be accompanied by one other person, provided that person furnishes proper identification.

MAINE:  You have the right, upon request, to be informed of whether an investigative consumer report was requested, and if one was requested, the name and address of the consumer reporting agency furnishing the report.  You may request and receive from the Company, within five business days of our receipt of your request, the name, address and telephone number of the nearest unit designated to handle inquiries for the consumer reporting agency issuing an investigative consumer report concerning you.  You also have the right, under Maine law, to request and promptly receive from all such agencies copies of any such reports.

 

WASHINGTON STATE:  If we request an investigative consumer report, you have the right, upon written request made within a reasonable period of time after your receipt of this disclosure, to receive from us a complete and accurate disclosure of the nature and scope of the investigation we requested.  You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act.

address of the consumer reporting agency furnishing the report. You may inspect and receive a copy of the report by contacting that agency.

AUTHORIZATION

I have carefully read and understand this Disclosure and Authorization form and the attached summary of rights under the Fair Credit Reporting Act.  By my signature below, I consent to the release of consumer reports and investigative consumer reports prepared by Intellishield, to the Company and its designated representatives and agents.  I understand that if the Company hires me, my consent will apply, and the Company may obtain reports, throughout my employment.

 

I also understand that information contained in my job application or otherwise disclosed by me before or during my employment, if any, may be used for the purpose of obtaining consumer reports and/or investigative consumer reports.

 

By my signature below, I authorize law enforcement agencies, learning institutions (including public and private schools and universities), information service bureaus, credit bureaus, record/data repositories, courts (federal, state and local), motor vehicle records agencies, my past or present employers, the military, and other individuals and sources to furnish any and all information on me that is requested by the consumer reporting agency.

 

By my signature below, I certify the information I provided on this form is true and correct.  I agree that this Disclosure and Authorization form in original, faxed or photocopied form, will be valid for any reports that may be requested by or on behalf of the Company.

California, Minnesota, or Oklahoma applicants only:

You will be provided with a free copy of any consumer reports or investigative consumer reports obtained on you if you check the box below.

**All Other States you will need to contact your Employer Directly.**

Background Check Requested:

Company Name:

Applicant Name:

*Input N/A if you do not have a former name/alias*

Former Name/Alias:

Social Security #:

Date of Birth:

Present Address:

Prior Addresses:

Drivers License Number and State:

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Applicant Signature:

**  This information will be used only for background screening purposes and will not be taken into consideration in any employment decisions.
Should you have any questions or concerns,contact us at
Admin@Sonictestlabs.com **

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