Fill and Sign the In Connection with Your Application for Employment or When Deciding Whether to Modify or Continue Your Employment If You Are Form

Authorization for Investigative Consumer Report In connection with your application for employment or during the course of your potential employment, we may obtain and use an "investigative consumer report" about you from a "consumer reporting agency." A "consumer reporting agency" is an organization that assembles or evaluates consumer credit information or other information on consumers for the purpose of furnishing "investigative consumer reports" to third parties. This report may include information as to your character, general reputation, personal characteristics and mode of living. This information may be obtained by contacting your previous employers and/or references supplied by you or others.In the event that information from the report is utilized in whole or in part in making an adverse decision with regard to your employment, we will provide you with a copy of the investigative consumer report and a description in writing of your rights under the law, prior to taking any adverse employment action against you. Please be advised that you have the right to request, in writing, that we make a complete and accurate disclosure of the nature and scope of the information requested. Such disclosure will be made to you within 5 days of the date on which we receive the request from you or within 5 days of the time the report was first requested.The Fair Credit Reporting Act gives you specific rights in dealing with consumer reporting agencies. You will be provided a summary of these rights along with this document. By your signature below, you hereby authorize us to obtain a consumer investigative report about you._______________________________________Applicant's Signature _______Date ____________________________Applicant's Printed Name ____________________________Applicant's Address ____________________________City/State/Zip ____________________________Social Security Number