Background Screening Authorization Form

Background Screening Authorization Form

The information requested below is collected solely for the purpose of aiding the Consumer Reporting Agency (CRA) in completing a background check on you.
BACKGROUND CHECK DISCLOSURE DOCUMENT

Event Services by Marylee, LLC (the “Company”) may order a “consumer report” (a background report) about you from a consumer reporting agency (CRA) in connection with your employment or your application for employment (including independent contractor or volunteer assignments, as applicable).

The consumer report may include information about your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. The Company may not order a consumer report about you without your written authorization (which you may provide through a separate document called the Authorization for Background Checks).

The Company may also request an “investigative consumer report” on you. An “investigative consumer report” is a type of consumer report that involves personal interviews conducted for the Company by the CRA, most commonly with an individual’s prior employers or references.

You have the right to request more information about the nature and scope of any investigative consumer report obtained on you by contacting the Company.

Additionally, the Fair Credit Reporting Act gives you specific rights in dealing with CRAs. You will find these rights summarized here - A Summary of Your Rights Under the Fair Credit Reporting Act.
Name*

First NameMiddle Name (Required) Last Name
Email
example@example.com
Enter any Nick Names Used
Enter any other names used. First Name, Middle Name, Last Name:
Social Security Number
Date of Birth

MonthDayYear
Date
Driver's License Number
State Issuing License
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dates you lived at the above address:
Additional Address 1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dates you lived at Additional Address 1:
Additional Address 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dates you lived at Additional Address 2:
Phone Number

Area CodePhone Number

AUTHORIZATION FOR BACKGROUND CHECKS

I authorize Event Services by Marylee, LLC (the “Company”) to obtain a consumer report(s) (or background report(s)) on me, including any investigative consumer reports. I also agree that a copy of this form is valid like the signed original.

The consumer reporting agency (CRA) ADP Screening and Selection Services, Inc. (ADP SASS) will prepare the background report for the Company. ADP SASS is located at 301 Remington Street, Fort Collins, CO, 80524, and can be reached by phone at 800-367-5933 or at www.adpselect.com.

I understand that, as allowed by applicable law, the Company may rely on this authorization to order additional background reports, including investigative consumer reports, (1) during my employment or time as a volunteer or independent contractor, as applicable and (2) from any CRA other than ADP SASS without asking me for my authorization again. I understand the Company may order background report(s) under my legal name and any other names I may have used.

I also authorize the following persons, agencies, and entities to disclose to ADP SASS and its agents all information about or concerning me, as allowed by law, including but not limited to: my past or present employers; learning institutions, including colleges and universities; law enforcement and all other federal, state and local agencies; federal, state and local courts; the military; credit bureaus; testing facilities; motor vehicle records agencies; if applicable, worker’s compensation injuries; all other private and public sector repositories of information; and any other person, organization, or agency with any information about or concerning me. As allowed by law, such disclosures may contain the following information pertaining to you: credit history; public records; a Social Security number verification; driving records; military service; credentials/certifications; and verification of prior employment and education.
Review Your rights under the Fair Credit Reporting Act here.
By signing and submitting this form, I am authorizing Event Services by Marylee, LLC to perform a background screening. I also acknowledging that I have reviewed and received the Summary of Rights under the Fair Credit Reporting Act.*

I agree and give my authorizationI do not give authorization
Signature*

Clear
Date signed*

MonthDayYear
Date
Should be Empty: