This authorization is required for us to complete your background check for University of Florida College of Pediatrics. The information you provide in this form is confidential and secure.

By completing the authorization online, you hereby certify that your electronic signature may be used as if it were your original handwritten signature by iReviewNow, SecurTest, Inc., and/or court researchers, investigators, or government entities to verify your authorization for your background check. You hereby give consent for SecurTest, Inc. to periodically re-check your background report without further notice or consent.

You may complete this authorization online by pressing "Next." The authorization will not be complete until you click the "Submit" button on the final page. You must complete this authorization in one sitting. YOUR INFORMATION IS SSL ENCRYPTED AND SECURE!

 

You must answer each question and press "Next."

The website and form are confidential and secure.  You can be confident that your personal identifiers are protected and encrypted.

I. I understand that an investigative report will be prepared and reported by SecurTest concerning my background, including any criminal history information, authentication of my identity, validity of any social security number issued by the Social Security Administration, and other background information. The Summary of Rights under the FCRA details additional information as defined by the FCRA. This background check is limited to an investigation of criminal records and validation of your identity and residence history.

I understand that SecurTest, Inc. and/or its background screening agents or investigators, or authorized parties, may be requesting information from public and private sources about any of the information noted earlier in this paragraph in connection with the company or organization requesting this investigative report. We do not check your credit report without an additional notice and authorization.

II. IF APPLICABLE, Medical and worker’s compensation information will only be requested in compliance with the Federal Americans with Disabilities Act (ADA) and/or any other applicable state laws. According to the Fair Credit Reporting Act (FCRA, Public Law 91-508, Title VI), I am entitled to know if the considerations for which I am applying are denied because of information obtained from a consumer reporting agency. If so, I will be notified and be given the name of the agency providing that report. This section II does not apply to you, though we must communicate this information to you.

III. I acknowledge that a telephonic, electronic, online, facsimile (FAX) or photographic copy of this release shall be as valid as the original. This release is valid for most federal, state and county agencies. I have received a copy of my Fair Credit Reporting Act (FCRA) rights found on page 10.

IV. I hereby authorize, without reservation, any financial institution, law enforcement agency, clerk of court, government agencies that store records, information service bureau, school, employer or insurance company contacted by SecurTest, Inc., or their background screening agents, investigators, or entities to furnish the information described in Section I.

 

Please note, regardless of your state of residency, you will have automatic access to your report through iReviewNow.

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As part of the background investigation for University of Florida College of Pediatrics, we verify the information you provide as being accurate.

The website and form are confidential and secure.  You can be confident that your personal identifiers are protected and encrypted.

 

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The following information is required by courts, law enforcement agencies, and other entities for positive identification purposes when checking public, government or official records. It is confidential and will not be used for any other purposes.

You MUST answer each question.

A scanned or photo image of your ID is will expedite your background check. You may upload a scanned copy or a cell phone photo of your Government issued ID.

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Once you have read the following summary of your rights under the Fair Credit Reporting Act, click "Next."

Para información en español, visite www.consumerfinance.gov/es, o escriba: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20006

The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records).  Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to www.consumerfinance.gov/learnmore or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20006.

§        You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment – or to take another adverse action against you – must tell you, and must give you the name, address, and phone number of the agency that provided the information.

§        You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your "file disclosure").  You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:

§        a person has taken adverse action against you because of information in your credit report;

§        you are the victim of identify theft and place a fraud alert in your file;

§        your file contains inaccurate information as a result of fraud;

§        you are on public assistance;

§        you are unemployed but expect to apply for employment within 60 days.

In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.consumerfinance.gov/learnmore for additional information.

§        You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus.  You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender.

§        You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See www.consumerfinance.gov/learnmore for an explanation of dispute procedures.

§        Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate.

§        Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old.

§        Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need – usually to consider an application with a creditor, insurer, employer, landlord, or other business.  The FCRA specifies those with a valid need for access.

§        You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer.  Written consent generally is not required in the trucking industry. For more information, go to www.consumerfinance.gov/learnmore.

§        You may limit "prescreened" offers of credit and insurance you get based on information in your credit report. Unsolicited "prescreened" offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-567- 8688.

§        You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.

§        Identity theft victims and active duty military personnel have additional rights. For more information, visit www.consumerfinance.gov/learnmore.

States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. For information about your federal rights, contact:

TYPE OF BUSINESS:                                CONTACT:

1. Type of business: a)      Banks, savings associations,   and credit unions with total assets of over $10 billion and their affiliates. b)      Such affiliates that are not banks, savings associations, or credit unions also should list, in addition to the Bureau:	a)      Bureau of Consumer Financial Protection     1700 G Street NW     Washington, DC 20006 b)      Federal Trade Commission: Consumer Response Center – FCRA      Washington, DC 20580      (877) 382-4357
2. To the extent not included in item 1 above: a)      National banks, federal savings associations, and federal branches and federal agencies of foreign banks b)      State member banks, branches and agencies of foreign banks (other than federal branches, federal agencies, and insured state branches of foreign banks), commercial lending companies owned or controlled by foreign banks, and organizations operating under section 25 or 25A of the Federal Reserve Act c)      Nonmember Insured Banks, Insured State Branches of Foreign Banks, and insured state savings associations d)      Federal Credit Unions	a)      Office of the Comptroller of the Currency Customer Assistance Group 1301 McKinney Street, Suite 3450 Houston, TX 77010-9050 b)      Federal Reserve Consumer Help Center P.O. Box 1200 Minneapolis, MN 55480 c)      FDIC Consumer Response Center 1100 Walnut Street, Box #11 Kansas City, MO 64106 d)      National Credit Union Administration Office of Consumer Protection (OCP) Division of Consumer Compliance and Outreach (DCCO) 1775 Duke Street Alexandria, VA 22314
3. Air carriers	Asst. General Counsel for Aviation Enforcement & Proceedings Department of Transportation 400 Seventh Street SW Washington, DC 20590
4. Creditors Subject to Surface Transportation Board	Office of Proceedings, Surface Transportation Board Department of Transportation 1925 K Street NW Washington, DC 20423
5. Creditors Subject to Packers and Stockyards Act	Nearest Packers and Stockyards Administration area supervisor
6. Small Business Investment Companies	Associate Deputy Administrator for Capital Access United States Small Business Administration 406 Third Street, SW, 8th Floor Washington, DC 20416
7. Brokers and Dealers	Securities and Exchange Commission 100 F St NE Washington, DC 20549
8. Federal Land Banks, Federal Land Bank Associations, Federal Intermediate Credit Banks, and Production Credit Associations	Farm Credit Administration 1501 Farm Credit Drive McLean, VA 22102-5090
9. Retailers, Finance Companies, and All Other Creditors Not Listed Above	FTC Regional Office for region in which the creditor operates or Federal Trade Commission: Consumer Response Center – FCRA Washington, DC 20580 (877) 382-4357

Consumers Have the Right To Obtain A Security Freeze

Pursuant to Title III of the “Economic Growth, Regulatory Relief, and Consumer Protection Act” (PL No. 115-174), you have a right to place a “security freeze” on your credit report, which will prohibit a consumer reporting agency from releasing information in your credit report without your express authorization. The security freeze is designed to prevent credit, loans, and services from being approved in your name without your consent. However, you should be aware that using a security freeze to take control over who gets access to the personal and financial information in your credit report may delay, interfere with, or prohibit the timely approval of any subsequent request or application you make regarding a new loan, credit, mortgage, or any other account involving the extension of credit.

As an alternative to a security freeze, you have the right to place an initial or extended fraud alert on your credit file at no cost. An initial fraud alert is a 1-year alert that is placed on a consumer’s credit file. Upon seeing a fraud alert display on a consumer’s credit file, a business is required to take steps to verify the consumer’s identity before extending new credit. If you are a victim of identity theft, you are entitled to an extended fraud alert, which is a fraud alert lasting 7 years.
A security freeze does not apply to a person or entity, or its affiliates, or collection agencies acting on behalf of the person or entity, with which you have an existing account that requests information in your credit report for the purposes of reviewing or collecting the account. Reviewing the account includes activities related to account maintenance, monitoring, credit line increases, and account upgrades and enhancements.
To place a security freeze or fraud alert on your credit report please contact the following consumer reporting agencies:

Equifax
https://www.freeze.equifax.com/Freeze/jsp/SFF_PersonalIDInfo.jsp

https://www.alerts.equifax.com/AutoFraud_Online/jsp/fraudAlert.jsp

Experian

https://www.experian.com/freeze/center.html
https://www.experian.com/fraud/center.html

TransUnion

https://www.transunion.com/credit-freeze/credit-freeze-faq.page

https://www.transunion.com/fraud-victim-resource/place-fraud-alert

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In accordance with the Fair Credit Reporting Act (FCRA, Public Law 91-508, Title VI), this information may only be used to verify a statement(s) made by an individual in connection with legitimate business needs. The depth of information available varies from state to state. Status of updates is available on request. Although SecurTest, Inc. has used reasonable methods and standards in its background screening and collection of information and every effort has been made to assure accuracy, SecurTest relies on sources of information which are outside of the control of SecurTest, as they are county, state, federal, and other official records. Final verification of an individual’s identity and proper use of report contents are the responsibility of University of Florida College of Pediatrics. SecurTest, Inc.’s policy requires purchasers of these reports to have signed a Service Agreement. This assures SecurTest, Inc., providers of official records, and SecurTest researchers, background screening investigators, and sources for such information that users of your report will abide by the FCRA and other legal obligations. If information contained in this report is responsible for disqualification, suspension or termination the requesting agency of this background report has agreed to give you immediate access to your SecurTest Report, iReviewNow, and your FCRA rights, among other required documentation.

By submitting my information, as the subject of the background check, I certify that I have received a copy of my FCRA Rights. I further affirm receipt of a copy of my SecurTest Background Report to the email provided and use of iReviewNow to verify the accuracy of the report.

I understand I can instantly review my report for FREE, identify errors or mistakes, report identity theft, dispute inaccuracies, provide comments using the iReviewNow Compliance System.

I agree to exclusively use iReviewNow to verify the accuracy of my background report, identify errors or mistakes, report identity theft, and dispute inaccuracies, and provide comments or feedback.

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You are almost finished! This is the last page. After you have read and signed the following, click "Submit" at the bottom of the page.

INSTANT ABILITY TO REVIEW YOUR REPORT.  The Employer or user procuring this report uses the exclusive patented iReviewNow software, which allows you to review your background (consumer) report to ensure that it is accurate.

 

 

How you benefit:

 

• You have an opportunity to see the contents of your background report prior to, at the same time ,or near the same time as the Company who you authorized to receive your report at iReviewNow.com or by email.

• You have an immediate opportunity to make sure the report is accurate, complete, and up-to-date, and to dispute any information you believe to be incomplete or inaccurate. You have an immediate opportunity to provide an explanation for any information contained in the report, especially information about your past, and proivde any mitigating circumstances that may assist the Company receiving your background report with any decisions based upon your report.

 

 

I agree to the following terms and conditions.

 

1.       I certify that the information provided on the Background Information Form  is my personal identifying information and is accurate and complete.

2.       I agree to review the consumer report about me for accuracy and completeness by exclusively using www.iReviewNow.com (hereafter “iReviewNow) as provided by iReviewNow, LLC.  I agree to go to iReviewNow.com to view my report, answer the iReviewNow questions, and dispute any inaccurate or incomplete information.. I agree to contact SecurTest, Inc., the consumer reporting agency and background screening provider, at (800) 445-8001 if I am unable to view my report at iReviewNow.com or have any questions about my report. 

3.       I agree and understand that iReviewNow, LLC is a software provider and is neither an employer nor a consumer reporting agency as defined by the Fair Credit Reporting Act.  I understand that iReviewNow, LLC is solely providing software through which I may electronically access my report. I understand that the consumer reporting agency who prepared my report is SecurTest, Inc. I understand that iReviewNow nor the consumer reporting agency who procured my report, do not make any employment or other decisions for the Company receiving my report, and the employer is solely responsible for all employment decisions.

4.       By consenting to use iReviewNow, I authorize all legal notices to be provided to me electronically through iReviewNow.com, the email address I have provided understanding that standard text messaging rates apply, as I will receive text messages alerting me to go to iReviewNow.com when my report or notices are ready for my review.

5.       I understand that if I do not view and confirm or dispute my report within five business days from the first text, email message or notice that my report is completed and ready for my review, the Company authorized to review my report may consider a decision based on the contents of my consumer report.

6.       I agree to go to iReviewNow.com to register for automated notification of my report or to view the report when notified.

7.       I have had an opportunity to read or review the Summary of My Rights Under the FCRA and other state notices, other applicable regulations, state and federal laws and consult with legal counsel. 

 

8.      ELECTRONIC SIGNATURE AUTHORIZATION: I hereby certify that if I elect to sign electronically that it may be used by the requesting agency, iReviewNow®, SecurTest®, Inc., and court researchers, investigators, or government entities to rely on it as if it were my original handwritten signature.

 

INVESTIGATIVE CONSUMER AGENCY CONDUCTING INVESTIGATION, unless noted herein:

 

SecurTest, Inc.

 

600 Grand Panama Blvd. Ste. 202

Panama City Beach, FL 32407

 

(800) 445-8001 | www.securtest.com

 

 

iReviewNow® – © 2005-2018 – Patented Intellectual Property of Steven C. Millwee and SecurTest, Inc. - ALL RIGHTS RESERVED

All of the notices required by law are found at SecurTestNotices.pdf. A copy of these notices are attached to the email transmitted to you when you click Submit.