HDI Background Investigation Consumer Report Disclosure Form
In connection with your application process for employment, contract service
and/or volunteer service with , HDI
Investigation & Executive Protection Service, Inc. 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.
You have the right to receive, upon your request within a reasonable
period of time, (not to exceed 30 days) a complete and accurate
disclosure of the nature and scope of the investigation requested. You
have the right to make a request to HDI Investigation & Executive
Protection Service, Inc. upon proper identification, to request the
nature and substance of all information in its files on you at the time
of your request, including the source of information and the recipients
of any reports on you that HDI Investigation & Executive Protection
Service, Inc. has previously furnished within the two year period
preceding your request. HDI Investigation & Executive Protection
Service, Inc. may be contacted at: 4801 E. Independence Blvd., Suite 809
Charlotte, North Carolina 28212, or by telephone at: (704) 567-7775
Also on the HDI Investigation web- page you will find a written summary
of your rights under the Fair Credit Reporting Act (FCRA) as prepared by
the Federal Trade Commission, which is available for you to print by
touching the print button underneath it.
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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