Consumer Report Authorization And Release Form
In connection with your application process for employment, contract service
and/or volunteer service with , HDI
Investigation & Executive Protection Service, Inc. (herein referred to
as HDI) may request a consumer report from various credit agencies
and/or data base information providers. These reports may include the
following types of information: verification of education, licensure,
employment, educational background, or any other information about you
which may reflect upon your potential for employment, contract or
volunteer work gathered from any individual organization, entity,
agency, or other source which may have knowledge, concerning any such
items of information. Such reports may contain public record information
concerning your driving record, worker’s compensation claims, credit,
bankruptcy proceedings, criminal records, etc., from federal, state and
other agencies which maintain such records.
I fully release and discharge HDI their respective affiliates,
subsidiaries, directors, officers, employees, agents and attorneys
thereof and each of them, and any individual, organization, entity,
agency, or other source providing information to HDI, from all claims
and damages arising out of or relating to any investigation of my
background for employment, contract or volunteer purposes. This release
is valid for all federal, state, county and local agencies, authorities,
previous employers, military services and educational institutions.
HDI is authorized to disclose all information obtained to the requesting
entity for the purpose of making a determination as to my eligibility
for employment, promotion or any other lawful purposes. If hired or
contracted, this authorization shall remain on file and shall serve as
ongoing authorization, where valid, for the procurement of consumer
reports at any time during my employment or contracted period
By checking yes, I certify that on
I have read and fully understand this disclosure and prior to checking
yes I was given an opportunity to ask questions and to have those
questions answered to my satisfaction. By checking yes, I am also
certifying that I have been provided with a copy of the summary of
rights of the consumer pursuant to the Fair Credit Reporting Act (FCRA)
Applicant's E-mail Address
Company's E-mail Address
Name of the Organization Requesting the BI
Your Name
File #
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