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AUTHORIZATION, WAIVER AND RELEASE OF LIABILITY
FOR CONSUMER CREDIT REPORT


In applying for employment with [YOUR COMPANY NAME] (Company), I hereby authorize the Company, or any designated agent(s) working in the Companys behalf to obtain and review my consumer credit report and or any other credit related information pertaining to me.

It is my understanding that the information being obtained will not be used in violation of any federal or state equal opportunity law or regulation, and that, before any adverse action is taken, based on upon review of such consumer credit report, I will be provided with a copy of said report as well as a summary of consumers rights. 

I hereby fully release the Company, and any and all of its employees, directors, agents, successors and assigns, and all contributing parties or sources from whom any information is lawfully obtained, from any and all claims or liability which is in any way related to this or any subsequent investigation(s) of my credit history.

I hereby state that all information I have provided to the Company, in any form, is true to the best of my knowledge. I understand that any known misrepresentation made to the Company by me will exclude me from further consideration as a candidate for employment or advancement, and may result in termination of my employment with the Company if I am hired or advanced by the Company before such misrepresentation is identified. I fully understand this authorization, waiver and release of liability is not an offer or a contract for employment by the Company. It is also understood that the Company operates under an AT-WILL EMPLOYMENT POLICY and this authorization and release does not alter or affect this policy in any manner.


I would like to receive a free copy of any consumer credit report relating to me that is reviewed by the Company.

(  Yes     (  No



EMPLOYEE            COMPANY



                          
Authorized Signature          Authorized Signature

                          
Print Name and Title          Print Name and Title

 






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