FCRA Information : Employment Release Statement
Prior to and for the duration of my employment (including contract for services) with you, I understand that investigative background inquiries are going to be made on myself. I understand that you will be requesting information from various Federal, State, Local and other agencies which maintain records concerning my past activities relating to my driving history, credit, criminal, civil and other experiences. These reports may also include inquiries regarding my educational history and past work experience and performance including reasons for termination of employment.
I authorize, without reservation, any party or agency contacted by this employer or its agents to furnish any of the above mentioned information or any other information requested.
A photocopy of this document is considered to be as valid as the original document.
Print full name:_____________________________________________
Current address:_____________________________________________
How long at address:__________________________________________
City:___________________State:______________Zip:______________
Previous address:____________________________________________
How long at address:__________________________________________
City:___________________State:______________Zip:______________
Social Security number:___________-____________-_____________
**Date of birth:_______/________/________
Driver's License number:________________________State__________
Signature_______________________________
**Date of birth to be used exclusively for record checking purposes.
____Residents of California and Minnesota Only: Please check here if you would like TriCor to mail you a copy of your consumer report at the address listed above.
A PDF version of this document which you can download and print at any time is available below for your convenience. It is provided in Adobe Acrobat (TM) format and requires Adobe Acrobat Reader (TM), a free product available below, to be viewed or printed.
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