In connection with my application for placement, I understand that an investigative report will be requested that includes information as to my character, work habits, performance, and experience along with reasons for disciplinary action or termination of past employment. I understand that as directed by policy and consistent with the job described, you may be requesting information from public and private sources about my criminal record, driving record, education, and previous employment.
The fact applicants have a criminal record will not be an automatic bar to employment or volunteer work. Factors such as age at the time of the criminal offense, seriousness and nature of the violation, time elapsed and subsequent rehabilitation will be considered.
I acknowledge that a telephonic facsimile (fax) or photographic copy shall be valid as the original. This release is valid in most federal, state, and county agencies.
I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, or other organization or person contacted by the employer or its agent to furnish the information described above.
Law enforcement agencies and other entities for positive identification purposes require the following information when checking records. It is confidential and will not be used for any other purpose.
VeriScreen®
Comprehensive Background Checks
AUTHORIZATION AND RELEASE TO OBTAIN INFORMATION for Boys and Girls Clubs of Wayne County Under the provisions of the Fair Credit Reporting Act, 15 USC, Section 1681 et seq., the Americans with Disabilities Act and all applicable federal, state, and local laws, I hereby authorize and permit VeriScreen, Inc. to obtain a consumer report and/or an investigative consumer report which may include the following:
1. My employment records;
2. Records concerning any driving, criminal history, credit history, civil record, workers' compensation (post-offer only) and drug testing;
3. (For truck drivers only) In accordance with the Department of Transportation Motor Carrier Safety Regulations, Section 382.413, information concerning alcohol and controlled substances for the past 3 years;
4. Verification of my academic and/or professional credentials; and information and/or copies of documents from any military service records.
I understand that an "investigative consumer report" may include information as to my character, general reputation, personal characteristics, and mode of living, which may be obtained by interviews with individuals with whom I am acquainted or who may have knowledge concerning any such items of information. I am entitled to know if employment or promotion is denied because of information obtained by my prospective employer from a Consumer Reporting Agency.
I agree that a copy of this authorization has the same effect as an original and if my application is accepted I understand that VeriScreen will be allowed to perform a background check on a yearly/quarterly or during the process of determining a promotion, re-certification, continued qualification or as the result of reasonable suspicion. I understand and acknowledge that under provision of the Fair Credit Reporting Act I may request a copy of any consumer report from the consumer reporting agency that compiled the report, after I have provided proper identification.
I authorize VeriScreen, Inc. to obtain and prepare an investigative consumer report as set forth above, as part of its investigation of my application as a volunteer or employee of Boys and Girls Club. This authorization shall remain in effect over the course of my employment or time while volunteering. Reports may be ordered periodically during the course of my employment or volunteering. NOTE: Except for those states where an annual release is required, i.e. California (CALIFORNIA- Continuing consent concept is inapplicable and a separate authorization must be requested each time a report is ordered. - CA Civ. Code 1786.22)
New York and Maine applicants or employees only: You have the right to inspect and receive a copy of any investigative consumer report requested by the Boys and Girls Club by contacting the consumer reporting agency identified above directly. You may also contact the Company to request the name, address, and telephone number of the nearest unit of the consumer reporting agency designated to handle inquiries, which the Company shall provide within 5 days.
New York applicants or employees only: Upon request, you will be informed whether or not a consumer report was requested by the Boys and Girls Club and if such report was requested, informed of the name and address of the consumer reporting agency that furnished the report. By signing below, you also acknowledge receipt of Article 23-A of the New York Correction Law.
Oregon applicants or employees only: Information describing your rights under federal and Oregon law regarding consumer identity theft protection, the storage and disposal of your credit information, and remedies available to you should you suspect or find that the Company has not maintained secured records is available to you upon request.
Washington State applicants or employees only: 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.
California applicants or employees only: By signing below you also acknowledge receipt of the Notice Regarding Background Investigation Pursuant to California Law. Please check this box and return this page if you would like to receive a copy of an investigative consumer report or consumer credit report at no charge if one is obtained by the Company whenever you have a right to receive such a copy under California Law.
Minnesota and Oklahoma applicants or employees only: Please check this box and return this page if you would like to receive a copy of a consumer report if one is obtained by the Company.