RELEASE FORM FOR CONSUMER REPORTS



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RELEASE AND AUTHORIZATION FORM FOR CONSUMER REPORTS AND

ACKNOWLEDGEMENT AND CONSENT TO DISCLOSURE TO PROSPECTIVE EMPLOYEES

As defined in the Fair Credit Reporting Act, a “consumer report” is “any written, oral, or other communication of any information by a consumer reporting agency bearing on a consumer’s criminal background, credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing the consumer’s eligibility for…employment purposes.” The definition of “consumer report” includes reports based on information gathered from personal interviews with friends, acquaintances and fellow workers, as well as reports based upon information compiled from public records (i.e., criminal records).

A “consumer reporting agency” is “any person which, for monetary fees, dues, or on a cooperative nonprofit basis, regularly engages in whole or in part in the practice of assembling or evaluating consumer credit information or other information on consumers for the purpose of furnishing consumer reports to third parties.” This definition includes individual investigators as well as any business entity that assembles “consumer reports”.

Under the Fair Credit Reporting Act, if Murray Resources, considers not to hire, promote, reassign (or maintain you in your current position), or retain you an employee based upon the report, you are entitled to certain information from Murray Resources. Murray Resources must provide you with a copy of the “consumer report”.

Murray Resources relies upon the information provided by Intelnet, Inc. and other third parties conducting consumer report investigations. To the extent any such service reports information that you believe to be untrue, inaccurate or unrelated to you, you are welcome to undertake action to dispute the information. To the extent inaccurate information relates to criminal matters, please contact the ID Department of the Sheriff’s Office at (713) 755-7334, the Sheriff’s Office will have you come in to be fingerprinted. Once the fingerprinting verifies you are not the individual on this report, the Sheriff’s Office will then issue a “THIS IS NOT ME” letter. Please bring this letter to our office for our file.

I have read the Discloser set forth above, and understand my rights as a “consumer” under the Fair Credit Reporting Act. I hereby authorize Murray Resources to request and obtain public criminal record information about me from Intelnet, Inc., CIC or from any “consumer reporting agency”. I further authorize Murray Resources to use any “consumer report” containing such information in making employment-related decisions, which may directly and adversely affect me. Additionally, I acknowledge and understand that Murray Resources will disclose all information gained about me through the process of conducting the consumer report, as well as a copy of the consumer report to any client of Murray Resources that expresses an interest in considering me for employment. I consent to the disclosure by Murray Resources to any of their client companies of such information and I hereby release and discharge Murray Resources associated with the release of such information to a client customer of Murray Resources. I further acknowledge that, upon my request, Murray Resources will provide me with notification of parties whom Murray Resources had disclosed a consumer report with regard to me. I am willing that a photocopy of this Release be accepted with the same authority as the original.

Name       Other/Former Names      

Present Address       County      

Previous Address       County      

Date of Birth       Race       Gender      

SS#      Driver’s License Number       State      

Professional License (Type)       State       Number      

SIGNATURE: DATE:      

Information such as date of birth, race and gender obtained from the above data will be used for EEO reports. This data will be kept separate from your application and will not influence the hiring decision.

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