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Release Form |
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Notice, Authorization, And Release Regarding Consumer Report
Notice To Applicant: As part of Essroc Cement Corp.?s employment screening process, the Company may obtain a consumer report with respect to an applicant for employment. This information will be obtained from a consumer reporting agency (hereinafter ?agency?), and will be evaluated with other information obtained during the screening process in connection with any hiring decision. The consumer report will not be used for any other purpose.
Intent Not To Hire Based On The Consumer Report: If, after reviewing the consumer report, the Company intends to make a decision not to hire an applicant, based in whole or in part on information contained in that report, the Company shall: (1) provide notice of such intent to the individual; and (2) with such notice, provide the individual with a copy of the report obtained by the Company and a written description of the individual?s rights, as prescribed by the Federal Trade Commission under section 1681g(c)(3) of the Fair Credit Reporting Act (hereinafter ?Act?).
Decision Not To Hire Based On The Consumer Report: If the Company then decides not to hire the applicant, based in whole or in part on information contained in the consumer report, the Company shall: (1) provide notice of such action to the individual; (2) provide to the individual the name, address, and telephone number of the agency (including any toll-free number established by the agency) that provided the report to the Company; (3) provide to the individual a statement that the agency did not make the decision not to hire the individual and is unable to provide the individual the specific reasons why such decision was made; (4) provide to the individual notice of his/her right to request and obtain, pursuant to section 1681j of the Act, a free copy of the report from the agency and to make a request for such report within 60 days of his/her receipt of notice from the Company informing him/her of the Company?s decision not to hire him/her, and additional notice that the individual may dispute with the agency the accuracy or completeness of any information in his/her consumer report, pursuant to section 1681i of the Act.
Applicant?s Authorization And Release: The undersigned applicant for employment with Essroc Cement Corp. has read and understands the above and his/her rights in connection therewith. The undersigned hereby authorizes Essroc Cement Corp. to obtain a consumer report from a consumer reporting agency regarding him/her. The undersigned hereby releases Essroc Cement Corp., its agents, and employees from any liability in connection with their use of the report or their reliance thereon in connection with any decision made by them. The undersigned understands that the investigative background inquiries to be made may include consumer, criminal, driving, and other records. These records may include information as to the undersigned?s character, work habits, performance, and experience along with reasons for termination of past employment. The undersigned understands that this report may also include information obtained from various government agencies which maintain records relating to driving, credit, criminal, civil, and other experiences as well as claims involving the undersigned in the files of insurance companies. I authorize, without reservation, any party or agency contacted by Essroc Cement Corp. or any consumer reporting agency used by Essroc Cement Corp. to furnish the above-mentioned information.
NOTE: All Fields Required
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