HomeMy Public PortalAboutA-Check Global Attention to ClientsAttention A -Check Global Clients
(craform001 v14:12.2016)
This U.S. Employment Screening Disclosure/Authorization Kit was designed by A -Check Global as a courtesy to our
clients to assist them with their regulatory responsibilities as an end user of consumer and investigative consumer reports
(background checks) in the United States. The kit contains eight [8] documents, (1) a Consumer Report Disclosure (2) an
Investigative Consumer Report Disclosure, (3) a California Applicant Disclosure of Rights Under State Law, (4) a
Consumer Credit Report Disclosure, (5) State Required Notices for Accessing Credit, (6) a Consumer Authorization form,
(7) a form requesting additional PII information, and (8) a Summary of Rights Under the Fair Credit Reporting Act (FCRA).
Please follow the Instructions to create your organization's compliance documentation. A -Check strongly recommends
that all documents are presented to the applicant as standalone documents with footer information indicating that each is
a separate document; be careful with the use of page numbers.
All information contained herein is provided solely for the convenience of the HR and Security communities we serve. A -
Check Global is not providing legal advice or counsel, thus this documents) should not be deemed as such. It is
imperative that you consult with your organization's legal counsel to ensure your final product complies with FCRA
§604(2) and state consumer reporting requirements.
Instructions:
1. For all Forms: Using the Word command "Find and Replace" enter the word "TOWN OF GULF STREAM" in the
Find section and your Company name in the Replace section. This can also be accomplished manually by
replacing the word "TOWN OF GULF STREAM" throughout the document with your Company name using the
copy and paste commands.
2. Optional: Double click the header and insert your company logo or copy and paste onto company letterhead.
3. For craform001: This is a required form and must be used regardless of jurisdiction or services ordered as part of
your company's background package.
4. For craform002: This is a required form only if your organization utilizes personal references or job performance
history in your screening process. If you don't order personal references or obtain job performance questions as
part of your employment verification process, you can delete this form.
5. For craform003: This is a required form only if you are an employer that is based in California or conducts
business in California. If you do not hire in California or applicants from California, you can delete this form.
6. For craform004: This is a required form only if your organization requests a credit report as part of your
background screening process and you are located in a state that requires disclosure. If you use credit, it is
recommended to include the form in your process regardless of state as several states are currently considering
laws to restrict the use of credit.
7. For craform005: This is a required form only if your organization requests a credit report as part of your
background screening process and you are located in a state that requires disclosure. Please review and execute
the printed instructions on the form.
8. For craform006: This is a required form and must be used regardless of jurisdiction or services ordered as part of
your company's background package. However, you can delete state notices contained on the form if they don't
apply to the jurisdiction you are hiring from. Also, review check boxes on the form prior to signature to ensure they
are relevant to your screening process.
9. For craform007: This is not a required form but will significantly reduce the amount of time it takes to process your
background check. Feel free to adjust the table requesting additional PII to the needs of your organization or
delete it if not needed.
10. For craform008: The FCRA Summary of Rights is required to be provided to the applicant for all "investigative"
consumer reporting service offerings which include employment and personal references. However, it is Best
Practice to provide the Summary of Rights to all applicants at the time of application regardless of the content of
your screening process.
11. This completes your Organization's consumer report forms. A -Check recommends that each form remains a
standalone document to help insulate your organization from intense legal scrutiny.
12. WARNING!: Adding language requiring the applicant to waive their rights or hold your organization harmless or
combining forms may render your forms non-compliant and could subject your organization to legal challenge.
Please ensure you do not include instructions in any of the forms you will be utilizing. If you have any questions, please
contact your Client Relations Representative +1.877.345.2021 or at clientrelations(o)acheckciobal.com.
"Delete this paragraph prior to using" Sample documents should NOT be construed as legal advice,
guidance or counsel. Employers should consult their own attorney about their compliance responsibilities
under the FCRA and applicable state law. A -Check Global expressly disclaims any warranties or responsibility
or damages associated with or arising out of information provided. Employers seeking credit reports must
provide additional notices pursuant to state law.
"end of section to be deleted"
craform001: Disclosure Regarding Background Investigation
TOWN OF GULF STREAM may obtain information about you from a third party consumer reporting
agency for employment purposes. Thus, you may be the subject of a "consumer report" which may
include information about your character, general reputation, personal characteristics, and/or mode of
living. These reports may contain information regarding your criminal history, social security
verification, motor vehicle records ("driving records'), verification of your education or employment
history, or other background checks.
You have the right, upon written request made within a reasonable time, to request whether a
consumer report has been run about you and to request a copy of your report. These searches will
be conducted by A -Check Global, 1501 Research Park Drive, Riverside, CA, 92507, 877-345-2021,
www.acheckglobal.com. The scope of this disclosure is all-encompassing, however, allowing the
Company to obtain from any outside organization all manner of consumer reports throughout the
course of your employment to the extent permitted by law.
I acknowledge receipt of this standalone consumer report disclosure:
Name:
Date:
**Delete this paragraph prior to using** Sample documents should NOT be construed as legal advice,
guidance or counsel. Employers should consult their own attorney about their compliance responsibilities
under the FCRA and applicable state law. A -Check Global expressly disclaims any warranties or responsibility
or damages associated with or arising out of information provided. Employers seeking credit reports must
provide additional notices pursuant to state law.
**end of section to be deleted**
craform002: Investigative Consumer Report Disclosure
TOWN OF GULF STREAM may request an investigative consumer report about you from a third
party consumer reporting agency', in connection with your employment or application for employment
(including independent contractor or volunteer assignments, as applicable). An "investigative
consumer report" is a background report that includes information from personal interviews (except in
California, where that term includes background reports with or without information obtained from
personal interviews). The most common form of an investigative consumer report in connection with
your employment is a reference check through personal interviews with sources such as your former
employers and associates, and other information sources. The investigative consumer report may
contain information concerning your character, general reputation, personal characteristics, mode of
living, or credit standing. You may request more information about the nature and scope of an
investigative consumer report, if any, by contacting TOWN OF GULF STREAM.
I acknowledge receipt of this standalone investigative consumer report disclosure:
1 Applicants/employees in California: TOWN OF GULF STREAM will notify you if a consumer reporting agency other
than A -Check Global, 1501 Research Park Drive, Riverside, CA, 92507, 1377-345-2021, www.acheckglobal.com is
used to obtain an investigative consumer report. A subsequent notice will be sent for future consumer reports requested.
**Delete this paragraph prior to using** Sample documents should NOT be construed as legal advice,
guidance or counsel. Employers should consult their own attorney about their compliance responsibilities
under the FCRA and applicable state law. A -Check Global expressly disclaims any warranties or responsibility
or damages associated with or arising out of information provided. Employers seeking credit reports must
provide additional notices pursuant to state law.
**end of section to be deleted**
craform003: Notice Regarding Background Checks Per California Law
TOWN OF GULF STREAM intends to obtain information about you for employment screening purposes from a
consumer reporting agency. Thus, you can expect to be the subject of "investigative consumer reports" and
"consumer credit reports" obtained for employment purposes. Such reports may include information about
your character, general reputation, personal characteristics and mode of living. With respect to any
investigative consumer report from an investigative consumer reporting agency ("ICRA"), the Company may
investigate the information contained in your employment application and other background information about
you, including but not limited to obtaining a criminal record report, verifying references, work history, your
social security number, your educational achievements, licensure, and certifications, your driving record, and
other information about you, and interviewing people who are knowledgeable about you. The results of this
report may be used as a factor in making employment decisions. The source of any investigative consumer
report (as that term is defined under California law) will be A -Check Global, 1501 Research Park Drive,
Riverside, CA, 92507, 877-345-2021, www.acheckglobal.com. The Company agrees to provide you with a
copy of an investigative consumer report when required to do so under California law.
Under California Civil Code section 1786.22, you are entitled to find out what is in the ICRA's file on you with
proper identification, as follows:
In person, by visual inspection of your file during normal business hours and on reasonable notice. You
also may request a copy of the information in person. The ICRA may not charge you more than the
actual copying costs for providing you with a copy of your file.
A summary of all information contained in the ICRA's file on you that is required to be provided by the
California Civil Code will be provided to you via telephone, if you have made a written request, with
proper identification, for telephone disclosure, and the toll charge, if any, for the telephone call is
prepaid by or charged directly to you.
By requesting a copy be sent to a specified addressee by certified mail. ICRAs complying with
requests for certified mailings shall not be liable for disclosures to third parties caused by mishandling
of mail after such mailings leave the ICRAs.
"Proper Identification" includes documents such as a valid driver's license, social security account number,
military identification card, and credit cards. Only if you cannot identify yourself with such information may the
ICRA require additional information concerning your employment and personal or family history in order to
verify your identity.
The ICRA will provide trained personnel to explain any information furnished to you and will provide a written
explanation of any coded information contained in files maintained on you. This written explanation will be
provided whenever a file is provided to you for visual inspection. You may be accompanied by one other
person of your choosing, who must furnish reasonable identification. An ICRA may require you to furnish a
written statement granting permission to the ICRA to discuss your file in such person's presence.
❑ Please check this box if you would like to receive a copy of an investigative consumer report or
consumer credit report at no charge if one is obtained by the Company whenever you have a right to
receive such a copy under California law.
I acknowledge receipt of this standalone investigative consumer report disclosure:
**Delete this paragraph prior to using** Sample documents should NOT be construed as legal advice,
guidance or counsel. Employers should consult their own attorney about their compliance responsibilities
under the FCRA and applicable state law. A -Check Global expressly disclaims any warranties or responsibility
or damages associated with or arising out of information provided. Employers seeking credit reports must
provide additional notices pursuant to state law.
**end of section to be deleted**
craform004: Consumer Credit Report Disclosure
TOWN OF GULF STREAM may request a credit "report" on you from a Consumer Reporting Agency at any
time during the application process or during your employment with TOWN OF GULF STREAM. TOWN OF
GULF STREAM will use such report(s) solely for employment purposes, e.g., to be considered for continued
employment in your current position or assignment as an employee of TOWN OF GULF STREAM, for
reassignment to another position, and/or as a condition to any future reassignment, promotion, retention or
rehiring.
The credit report is a consumer report, which pursuant to Section 603 of the Fair Credit Reporting Act (FCRA)
may include information regarding your "credit worthiness, credit standing, credit capacity, character, general
reputation, personal characteristics, or mode of living." The scope of the credit history report may include
information concerning your identity, past addresses, and Social Security Number—some employment history
information may be included. A credit report will only be processed in accordance with federal, state, or local
statute or ordinance for procuring credit reports in the hiring process, all state required disclosures will follow
on separate document.
I acknowledge receipt of this standalone consumer credit report disclosure
**Delete this paragraph prior to using** Sample documents should NOT be construed as legal advice,
guidance or counsel. Employers should consult their own attorney about their compliance responsibilities
under the FCRA and applicable state law. A -Check Global expressly disclaims any warranties or responsibility
or damages associated with or arising out of information provided. Employers seeking credit reports must
provide additional notices pursuant to state law.
Note: The following states have restrictions for utilizing credit reports in the applicant screening process but do not require
notice to the applicant, please review with your legal your requirements under these laws:
Colorado: Pursuant to Colorado S.B. 18, employers may only request a credit report if such is substantially related to a current job or potential
job — requirements are outlined within the legislation.
Connecticut: Pursuant to Connecticut Public Act 11-223, employers may only request a credit report if such is substantially related to a current
job or potential job - requirements are outlined within the legislation.
Hawaii: Pursuant to Hawaii HRS §378-2.7, employers may not inquire into an employment applicant's credit history or credit score until the
applicant has received a conditional offer of employment.
Illinois: Pursuant to Illinois HB4658, employers may not inquire about or obtain a credit report unless the employer is excluded or there is an
exemption for a specific position — positions are outlined within the legislation.
Nevada: Pursuant to Nevada S.B. No. 127, employers may only request a credit report if such is substantially related to a current job or
potential job — positions are outlined within the legislation.
Philadelphia, PA: Pursuant to City of Philadelphia 0-1130, employers may not inquire about or obtain a credit report unless the employer is
excluded or there is an exemption for a specific position — positrons are outlined within the legislation.
Instructions: The five states and New York City below all require disclosure to the applicant prior to processing a credit
report in the screening process. Read each state section carefully. For each jurisdiction except WA, select the reasons
you will be processing a credit report and delete all others; for Washington please construct a short narrative on why a
credit report is necessary to be processed for the position the applicant is applying for.
**end of section to be deleted**
craform005 - State Required Notices required only for Obtaining a Credit Report for Hiring
Attention Applicants: If you are a resident of any of the following states, please review the additional rights afforded to
residents of that state when a credit report is requested for hiring consideration.
For California Only: Pursuant to California AB 22, employers are restricted in their use of credit reports for employment screening purposes.
The following are the permissible purposes for obtaining a credit report in the applicant screening process, the purpose for accessing your
credit report has been checked:
❑ A managerial position covered by the executive exemption set forth in subparagraph (1) of paragraph (A) of Section 1 of Wage
Order 4 of the Industrial Welfare commission
❑ a position In the California Department of Justice.
❑ a sworn peace officer or other law enforcement position.
❑ a position for which credit information is required by law to be disclosed or obtained.
❑ a position that involves regular access (other than in connection with routine solicitation of credit card applications in a retail
establishment) to people's bank or credit card account information, social security number, and date of birth.
❑ a position in which the employee would be a named signatory on the employer's bank or credit card account, authorized to transfer
money on behalf of the employer, or authorized to enter Into financial contracts on behalf of the employer.
❑ a position that involves regular access to cash totaling $10,000 or more of the employer, a customer, or client during the workday.
❑ a position that involves access to confidential or proprietary information (defined as a legal "trade secret" under Civil Code
3426.1(d)).
❑ For Maryland Only: Pursuant to the Maryland Code Labor and Employment § 3-711, an employer may request a credit report on
an applicant after an offer for employment has been made for a substantially job-related purpose. The purpose for accessing your
credit report has been checked:
❑ A manager of a business, department, division, unit or agency
❑ Those having access to personal information of a customer, employee or employer (except customer information supplied in
a typical retail transaction is not included)
❑ A position having a fiduciary responsibility to the employer, including the issuance of payments, collecting debts, transfer of
money or entering into contracts on behalf of employer
❑ An employee having an expense account or corporate debit or credit card
❑ An employee with access to a formula, pattern, computation, program, device, method, technique or process that (a) is a
business secret and the one who discloses could obtain economic value therefrom and (b) the employer maintains
reasonable procedures to keep the Information secret; 6) An employee who has access to other confidential business
information
❑ required by federal or state law
❑ if employer is insured financial institution, including affiliate or subsidiary
❑ Credit Union Shared Guaranty Corporation approved by the Maryland Commissioner of Financial Regulation
0 An entity registered as an investment advisor by the U.S. Securities and Exchange Commission.
craform005 -State Required Notices required only for Obtaining a Credit Report for Hiring (cont.)
❑ For Oregon Only: Pursuant to Ore Adm. Code 839-005-0080 employers may only request a credit report if such is substantially
related to a current job or potential job. The purpose for accessing your credit report has been checked:
❑ essential job function to have access to financial information beyond that customarily is a part of a retail transaction such as
an exchange of cash, checks, credit or debit cards. The processing of loans or extensions of credit would permit a credit
report if access to more detailed financial information is required to do the jab
❑ credit report is necessary to obtain a surety or fidelity bond
❑ Placement at a financial institution that is federally insured
❑ Required by state or federal law to use individual credit history for employment
❑ Employment of police officers for any: city, port, school district, mass -transit district, county, Indian reservation, the Criminal
Justice Division of the Department of Justice, Oregon Stale Lottery Commission or the Governor and who is responsible for
enforcing the criminal laws of this state or laws or ordinances related to airport security
❑ If the credit information is substantially job related and the employer's reasons for the use of such information are disclosed
to the subject in writing.
❑ For Vermont Only: Pursuant to Vermont Act No. 154 (sec. 95) employers may only request a credit report if such is substantially related
to a current job or potential job. The following are positions where a credit report is deemed substantially job related:
❑ The report is required by state/federal law/regulation
❑ Individual will have access to confidential financial information of a commercial value obtained by specific authorization by the
customer or client — normally handled by managers and those employees who must know the information to perform their job
❑ Financial institutions and credit unions
❑ Law enforcement
❑ Emergency medical personnel
❑ Firefighters
❑ Those with the financial fiduciary responsibilities regarding making payments, collecting debts, transferring money or entering into
contracts
❑ Will have access to payroll information
❑ Where credit information is a "valid and reliable predictor of employee performance"
❑ For Washington Only: Pursuant to RCW §19.182.020, employers may only request a credit report if such is substantially related to a
current job or potential job. TOWN OF GULF STREAM will be requesting a copy of your credit report for the following reason:
❑ For New York City, NY Only: Pursuant to New York City's "Stop Credit Discrimination In Employment Act (SCDEA)" employers
may only request a credit report for one of the following permissible purposes:
❑ where employers are required by state or federal law or regulations, or by a self-regulatory organization (such as FINRA) to
use an individual's consumer credit history for employment purposes;
❑ police officers, peace officers, or those in a position with law enforcement or investigative function at the City of New York
Department of Investigation ("DOI") (or in certain positions subject to background investigation by the DOI);
❑ certain positions working for the City of New York subject to a background investigation by the DOI;
❑ positions requiring the employee to be bonded by City, state or federal law;
❑ positions requiring the employee to possess a security clearance under federal or state law;
❑ non -clerical positions having regular access to trade secrets, intelligence information or national security information;
❑ positions having signatory authority over third party funds or assets valued at $10,000 or more, or positions that involve a
fiduciary responsibility to the employer with authority to enter financial agreements on behalf of the employer for $10,000 or
more; and
❑ positions that allow the employee to modify digital security systems protecting the employer or client's networks or
databases.
**Delete this paragraph prior to using** Sample documents should NOT be construed as legal advice,
guidance or counsel. Employers should consult their own attorney about their compliance responsibilities
under the FCRA and applicable state law. A -Check Global expressly disclaims any warranties or responsibility
or damages associated with or arising out of information provided. Employers seeking credit reports must
provide additional notices pursuant to state law.
**end of section to be deleted**
craform006 - Consumer Report Authorization
I acknowledge receipt of the separate document entitled DISCLOSURE REGARDING BACKGROUND
INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and
certify that I have read and understand both of those documents. I hereby authorize the obtaining of
'consumer reports' and/or "investigative consumer reports" by the Employer at any time after receipt of this
authorization and throughout my employment, if applicable.
To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or
federal agency, institution, school or university (public or private), information service bureau, employer, or
insurance company to furnish any and all background information requested by A -Check Global, 1501
Research Park Drive, Riverside, CA, 92507, 877-345-2021, www.acheckglobal.com, and/or Employer
itself. I agree that a facsimile ("fax"), electronic or photographic copy of this Authorization shall be as valid as
the original.
New York applicants only: Upon request, you will be informed whether or not a consumer report was
requested by the Company, and if such report was requested, informed of the name and address of the
consumer reporting agency that furnished the report. You have the right to inspect and receive a copy of any
investigative consumer report requested by the Company by contacting the consumer reporting agency
identified above directly. By signing below, you acknowledge receipt of Article 23-A of the New York
Correction Law.
Washington State applicants only: You also have the right to request from the consumer reporting agency a
written summary of your rights and remedies under the Washington Fair Credit Reporting Act.
Minnesota and Oklahoma applicants only: Please check this box if you would like to receive a copy of a
consumer report if one is obtained by the Company. ❑
Authorizing Signature
I certify that I have carefully read and understand each document presented to me including:
11 Please check box acknowledging receipt of standalone Disclosure Regarding Background Investigation.
O Please check box acknowledging receipt of standalone Investigative Report Disclosure.
O Please check box acknowledging receipt of my Notice Regarding Background Check per California Law.
O Please check box acknowledging receipt of my Consumer Credit Report Disclosure.
The following is my true and complete legal name and all information is true and correct to the best of my
knowledge:
**Delete this paragraph prior to using** Sample documents should NOT be construed as legal advice,
guidance or counsel. Employers should consult their own attorney about their compliance responsibilities
under the FCRA and applicable state law. A -Check Global expressly disclaims any warranties or responsibility
or damages associated with or arising out of information provided. Employers seeking credit reports must
provide additional notices pursuant to state law.
**end of section to be deleted**
craform007 - Request for Additional Personal Identifying Information
Attention:
The security of Your Personally Identifying Information is important to us therefore this form has been created
as a standalone form to ensure it is not transmitted to any other entity during the screening process. This
information will be utilized for identification purposes only to expedite the background check process.
All information requested will be held in strict confidence.
Please Print:
Cell Phone Number:
Email Address:
First Name: Middle Name. Last Name:
Present Street Address.
Social Security Number:
Former Street Address (Past 7 Years) City
Former Street Address (Past 7 Years) City
Former Street Address (Past 7 Years) City
Former Street Address (Past 7 Years) City
Alternate Phone Number:
Maiden Name or Other Names Used:
City:
State:
Zip:
Driver's License State & Number:
DOB.
State Zip
From:
To:
Stale Zip
From:
To:
State Zip
From:
To:
State Zip
From:
To:
Professional License: Type: State: Number.
craform008 - FCRA Summary of Rights
Para informacidn an espanol, visite www.consumerfinance.cov/learnmore o ascribe a la Consumer Financial Protection Bureau,
1700 G Street N. W, Washington, DC 20552.
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 20552.
• 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 identity 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.consumerrinance.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.consumerfiinance.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 tacking industry. For more information, go to www.consumerrinance.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
+1-888-5-OPTOUT (+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. con su merfi na nce. gov/I earn more.
craform008 - FCRA Summary of Rights (cont.)
TYPE OF BUSINESS:
CONTACT:
1.a. Banks, savings associations, and credit unions with total
a. Consumer Financial Protection Bureau
assets of over $10 billion and their affiliates
1700 G Street NW
Washington, DC 20552
b. Such affiliates that are not banks, savings associations, or credit
unions also should list, in addition to the CFPB:
b. Federal Trade Commission: Consumer Response Center—
FCRA
Washington, DC 20552
+1(877)382-4357
2. To the extent not included in item 1 above:
a. Office of the Comptroller of the Currency
Customer Assistance Group
a. National banks, federal savings associations, and federal
1301 McKinney Street, Suite 3450
branches and federal agencies of foreign banks
Houston, TX 77010-9050
b. Stale member banks, branches and agencies of foreign banks
b. Federal Reserve Consumer Help Center
(other than federal branches, federal agencies, and Insured State
P.O. Box 1200
Branches of Foreign Banks), commercial lending companies
Minneapolis, MN 55480
owned or controlled by foreign banks, and organizations operating
under section 25 or 25A of the Federal Reserve Act
c. FDIC Consumer Response Center
1100 Walnut Street, Box #11
c. Nonmember Insured Banks, Insured State Branches of Foreign
Kansas City, MO 64106
Banks, and Insured state savings associations
d. National Credit Union Administration
d. Federal Credit Unions
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
Aviation Consumer Protection Division
Department of Transportation
1200 New Jersey Avenue, S.E.
Washington, DC 20423
4. Creditors Subject to the Surface Transportation Board
Office of Proceedings, Surface Transportation Board
Department of Transportation
395 E. Street, S.W.
Washington, DC 20423
5. Creditors Subject to Packers and Stockyards Act, 1921
Nearest Packers and Stockyards Administration area supervisor
6. Small Business Investment Companies
Associate Deputy Administrator for Capital Access
United States Small Business Administration
409 Third Street, SW, 8th Floor
Washington, DC 20549
7. Brokers and Dealers
Securities and Exchange Commission
100 F St., N.E.
Washington, DC 20549
S. Federal Land Banks, Federal Land Bank Associations, Federal
Farm Credit Administration
Intermediate Credit Banks, and Production Credit Associations
1501 Farm Credit Drive
McLean, VA 22102-5090
9. Retailers, Finance Companies, and All Other Creditors Not
FTC Regional Office for region in which the creditor operates or
Listed Above
Feder I Trade Commission: Consumer Response Center—
FC
Washington, DC 20552
+1(877) 382-4357
New York correction Law Article 23-A
NEW YORK CORRECTION LAW
ARTICLE 23-A
A COPY OF THIS LAW IS BEING PROVIDED TO YOU IN CONJUNCTION WITH OUR ORDERING
BACKGROUND REPORTS ON YOU.
New York Bus Code §380-c(b)(2) and 380-g(d)
§750. Definitions. For the purposes of this article, the following terms shall have the following
meanings:
(1) "Public agency" means the state or any local subdivision thereof, or any state or local department,
agency, board or commission.
(2) "Private employer" means any person, company, corporation, labor organization or association
which employs ten or more persons.
(3) "Direct relationship" means that the nature of criminal conduct for which the person was convicted
has a direct bearing on his fitness or ability to perform one or more of the duties or responsibilities
necessarily related to the license, opportunity, orjob in question.
(4) "License" means any certificate, license, permit or grant of permission required by the laws of this
state, its political subdivisions or instrumentalities as a condition for the lawful practice of any
occupation, employment, trade, vocation, business, or profession. Provided, however, that "license"
shall not, for the purposes of this article, include any license or permit to own, possess, carry, or fire
any explosive, pistol, handgun, rifle, shotgun, or other firearm.
(5) "Employment" means any occupation, vocation or employment, or any form of vocational or
educational training. Provided, however, that 'employment" shall not, for the purposes of this article,
include membership in any law enforcement agency.
§751. Applicability. The provisions of this article shall apply to any application by any person for a
license or employment at any public or private employer, who has previously been convicted of one
or more criminal offenses in this state or in any other jurisdiction, and to any license or employment
held by any person whose conviction of one or more criminal offenses in this state or in any other
jurisdiction preceded such employment or granting of a license, except where a mandatory forfeiture,
disability or bar to employment is imposed by law, and has not been removed by an executive
pardon, certificate of relief from disabilities or certificate of good conduct. Nothing in this article shall
be construed to affect any right an employer may have with respect to
an intentional misrepresentation in connection with an application for employment made by a
prospective employee or previously made by a current employee.
§752. Unfair discrimination against persons previously convicted of one or more criminal
offenses prohibited. No application for any license or employment, and no employment or license
held by an individual, to which the provisions of this article are applicable, shall be denied or acted
upon adversely by reason of the individuals having been previously convicted of one or more criminal
offenses, or by reason of a finding of lack of 'good moral character' when such finding is based upon
the fact that the individual has previously been convicted of one or more criminal offenses, unless:
(1) There is a direct relationship between one or more of the previous criminal offenses and
the specific license or employment sought or held by the individual; or
(2) the issuance or continuation of the license or the granting or continuation of the
employment would involve an unreasonable risk to property or to the safety or welfare of specific
individuals or the general public.
§753. Factors to be considered concerning a previous criminal conviction; presumption.
1. In making a determination pursuant to section seven hundred fifty—two of this chapter, the public
agency or private employer shall consider the following factors:
(a) The public policy of this state, as expressed in this act, to encourage the licensure and
employment of persons previously convicted of one or more
criminal offenses.
(b) The specific duties and responsibilities necessarily related to the license or employment
sought or held by the person.
(c) The bearing, if any, the criminal offense or offenses for which the person was previously
convicted will have on his fitness or ability to perform one or more such duties or
responsibilities.
(d) The time which has elapsed since the occurrence of the criminal offense or offenses.
(e) The age of the person at the time of occurrence of the criminal offense or offenses.
(f) The seriousness of the offense or offenses.
(g) Any information produced by the person, or produced on his behalf, in regard to his
rehabilitation and good conduct.
(h) The legitimate interest of the public agency or private employer in protecting property, and
the safety and welfare of specific individuals or the general public.
2. In making a determination pursuant to section seven hundred fifty—two of this chapter, the public
agency or private employer shall also give consideration to a certificate of relief from disabilities or a
certificate of good conduct issued to the applicant, which certificate shall create a presumption of
rehabilitation in regard
to the offense or offenses specified therein.
§754. Written statement upon denial of license or employment. At the request of any person
previously convicted of one or more criminal offenses who has been denied a license or employment,
a public agency or private employer shall provide, within thirty days of a request, a written statement
setting forth the reasons for such denial.
§755. Enforcement.
1. In relation to actions by public agencies, the provisions of this article shall be enforceable by a
proceeding brought pursuant to article seventy—eight of the civil practice law and rules.
2. In relation to actions by private employers, the provisions of this article shall be enforceable by the
division of human rights pursuant to the powers and procedures set forth in article fifteen of the
executive law, and, concurrently, by the New York city commission on human rights.