Pursuant to the Federal Fair Credit Reporting Act (FCRA), I hereby authorize ZBM Zierke Built Manufacturing INC and its designated agents and representatives to conduct a comprehensive review of my background through a consumer report and/or an investigative consumer report to be generated for employment.  I understand the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas:  verification of Social Security number; current and previous residences; employment history; credit history and reports; criminal history, including records from any criminal justice agency in any or all federal, state or county jurisdictions; birth records, motor vehicle records, including traffic citations and registration; and any other public records.


I,                                                                                     authorize the complete release of these records or data pertaining to me which and individual, company, firm, corporation or public agency may have.  I understand that I must provide my date of birth to adequately complete said screening and acknowledge that my date of birth will not affect any hiring decisions. I hereby authorize and request any present or former employer, school, police department, financial institution or other persons having personal knowledge of me to furnish ZBM Zierke Built Manufacturing INC or its designated agents with all information in their possession regarding me in connection with an application of employment.  I am authorizing that a photocopy of this authorization be accepted with the same authority as the original.


I hereby release ZBM Zierke Built Manufacturing INC and its agents, officials, representatives or assigned agencies, including officers, employees or related personnel, both individually and collectively, from all liability for damages of whatever kind, which may at anytime result to me, my heirs, family or associates because of compliance with this authorization and request to release.  You may contact me as indicated below.  I understand that a copy of this authorization may be given at any time, provided I do so in writing.


I understand that pursuant to the federal Fair Credit Reporting Act, if any adverse action is to be taken based upon the consumer report, a copy of the report and a summary of the consumer’s right will be provided to me.

 

Completed by Candidate:  (Please Print Clearly)

 

Name:

 

 

Address:

 

 

Phone Number:                                          Sex:                                 SSN:

 

 

Email:                                                                                      Date of Birth:

 

 

Driver's License:

 

 

Prior Address:

 

 

Prior Address:

 

 

Prior Address:

 

 

 

 

 

 

 

Employee Signature:                                                              Date Signed:
 

AUTHORIZATION FOR RELEASE OF INFORMATION

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