CONSUMER REPORT AUTHORIZATION AND DISCLOSURE FORM
I authorize IPPC Pharmacy to request and procure an investigative consumer report concerning me for employment purposes. I understand that this investigative consumer report may include information concerning my character, general reputation, personal characteristics, and mode of living. I understand that investigative information may be obtained through personal interviews with my neighbors, friends, associates, or other acquaintances.
I also authorize IPPC Pharmacy to communicate the information in my investigative consumer reports to any of its divisions, departments, parents, and subsidiaries as may be necessary for legitimate business needs. I understand that if I do not wish such information to be communicated to such affiliates, I will notify IPPC Pharmacy’s Management in writing within five (5) business days of signing this Authorization and Disclosure Form.
I understand that IPPC Pharmacy will provide me with a copy of the investigative report it may have procured if I request such a copy of such investigative report within thirty (30) days after signing this Authorization and Disclosure Form. I also understand that, if I make such a request, IPPC Pharmacy will mail or otherwise deliver me a copy of the investigative report within five (5) days of the date of my request or of the date on which IPPC Pharmacy receives the investigative report, whichever is later.
This authorization is continuing, and does not expire, so that IPPC Pharmacy may use this same authorization at some time(s) in the future to request and procure additional reports as may be necessary for employment purposes, including but not limited to future promotion or retention.
A Summary of Your Rights User the Fair Credit Reporting Act
The federal Fair Credit Reporting Act (FCRA) is designed to promote accuracy, fairness, and privacy of information in the files of every “consumer reporting agency” (CRA). Most CRAs are credit bureaus that gather and sell information about you – such as if you pay your bills on time or have filed bankruptcy – to creditors, employers, landlords, and other businesses. You can find the complete text of the FCRA, 15 U.S.C. 1681 – 1681 u. at the Federal Trade Commission’s web site (http://ftc.gov). The FCRA gives you specific rights, as outlined below. You may have additional rights under state law. You may contact a state of local consumer protection agency or a state attorney general to learn those rights.
You must be told if information in your file has been used against you. Anyone who uses information from a CRA to take action against you – such as denying an application for credit, insurance, or employment – must tell you,, and give you the name, address, and phone number of the CRA that provided the consumer report.
You can find out what is in your file. At your request, a CRA must give you the information in your file, and a list of everyone who has requested if recently. There is no charge for the report if a person has taken action against you because of information supplied by CRA, if you request the report within 60 days of receiving notice of the action. You are also entitled to one free report every twelve months upon request if you certify that (1) you are unemployed and plan to seek employment within 60 days, (2) you are on welfare, or (3) your report is inaccurate due to fraud. Otherwise, a CRA may charge you up to eight dollars.
You can dispute inaccurate information with the CRA. If you tell a CRA that your file contains inaccurate information, the CRA must investigate the items (usually within 30 days) by presenting to its information source all relevant evidence you submit, unless your dispute is frivolous. The source must review your evidence and report its findings to the CRA. (The source also must advise national CRAs – to which it has provided the data – of any error.) The CRA must give you a written report of the investigation and a copy of your report if the investigation results in any change. If the CRA’s investigation does not resolve the dispute, you must add a brief statement to your file. The CRA must normally include a summary of your statement in future reports. If an item is deleted or a dispute statement is filed, you may ask that anyone who has recently received your report be notified of the change.
Inaccurate information must be corrected or deleted. A CRA must remove or correct inaccurate or unverified information from its files, usually within 30 days after you dispute it. However, the CRA is not required to remove accurate data from your file unless it is outdated (as described below) or cannot be verified. If your dispute results in any change to your report, the CRA cannot reinsert into your file a disputed item unless the information source verifies its accuracy and completeness. In addition, the CRA must give you a written notice telling you it has reinserted the item. The notice must include the name, address and phone number of the information source.
You can dispute inaccurate items with the source of the information. If you tell anyone – such as a creditor who report to a CRA – that you dispute an item, they may not then report the information to a CRA without including a notice of your dispute. In addition, once you’ve notified the source of the error in writing, it may not continue to report the information if it is, in fact, an error.
Outdated information may not be reported. In most cases, a CRA may not report negative information that is more than seven years old; ten years for bankruptcies.
Access to your file is limited. A CRA may provide information about you only to people with a need recognized by the FCRA – usually to consider an application with a creditor, insurer, employer, landlord, or other business.
Your consent is required for reports that are provided to employers, or reports that contain medical information. A CRA may not give information about you to your employer, or prospective employer, without your written consent. A CRA may not report medical information about you to creditors, insurers, or employers without your permission.
You may choose to exclude your name from CRA lists for unsolicited credit and insurance offers. Creditors and insurers may use file information as the basis for sending you unsolicited offers of credit or insurance. Such offers must include a toll-free phone number for you to call if you want your name and address removed from future lists. If you call, you must be kept off the lists for two years. If you request, complete, and return the CRA form provided for this purpose, you must be taken off the lists indefinitely.
You may seek damages from violators. If a CRA, a user or (in some cases) a provider of CRA data, violates the FCRA, you may sue them in state or federal court.
The FCRA gives several different federal agencies authority to enforce the FCRA:
FOR QUESTIONS OR CONCERNS REGARDING:
PLEASE CONTACT:
CRAs, creditors and others not listed below
Federal Trade Commission
Consumer Response Center – FCRA
Washington, DC 20580
202-326-3761
National banks, federal branches / agencies of foreign banks (word “National” or initials “N.A.” appear in or after bank’s name)
Office of the Comptroller of the Currency
Compliance Management, Mail Stop 6-6
Washinton, DC 20219
800-613-6743
Federal Reserve System member banks (except national banks, and federal branches / agencies of foreign banks)
Federal Reserve Board
Division of Consumer & Community Affairs
Washington, DC 20551
202-452-3693
Savings associations and federally chartered savings banks (word “Federal” or initials “F.S.B.” appear in federal institutions name)
Office of Thrift Supervision
Consumer Programs
Washington, DC 20552
800-842-6929
Federal credit unions (words “Federal Credit Union” appear in institutions name)
National Credit Union Administration
1775 Duke Street
Alexandria, VA 22314
703-518-6360
State-chartered banks that are not members of the Federal Reserve System
Federal Deposit Insurance Corporation
Division of Compliance & Consumer Affairs
Washinton, DC 20429
800-934-FDIC
Air, surface, or rail common carriers regulated by former Civil Aeronautics Board or Interstate Commerce Commission.
Department of Transportation
Office of Financial Management
Washinton, DC 20590
202-366-1306
Activities subject to the Packers and Stockyards Act. 1921
Department of Agriculture
Office of Deputy Administrator – GIPSA
Washinton, DC 20250
202-720-7051