licensed private detectivescsdgroup.cyscopa.com/.../pdm/policies_and_procedures/asg_ackno… ·...
TRANSCRIPT
Licensed Private Detectives
NOTICE AND ACKNOWLEDGMENT
NOTICE REGARDING BACKGROUND INVESTIGATION
may obtain informationabout you from a consumer reportingagency for employmentpurposes.Thus,you maybe the subjectof a "consumerreport"and/oran "investigativeconsumerreport"whichmayincludeinformationaboutyourcharacter,generalreputation,personalcharacteristics,drivingrecord,and/ormodeof living,and whichcan involvepersonalinterviewswith sourcessuch as your currentand past employers,friends,orassociates.Thesereportsmaybe obtainedat anytimeafter receiptof yourauthorizationand, if you are hired,throughoutyouremployment.Youhavetheright,uponwrittenrequestmadewithina reasonabletimeafterreceiptofthis notice,to requestdisclosureof the natureandscopeof anyinvestigativeconsumerreport. Pleasebe advisedthat the natureand scopeof the mostcommonform of investigativeconsumerreportobtainedwith regardtoapplicantsfor employmentis an investigationinto your educationand/or employmenthistoryconductedbyAdvancedSurveillanceGroup,40MacombPlace,Ste201,Mt. Clemens,M148043.(888)677.9700.Thescopeof thisnoticeandauthorizationis all-encompassing,however,allowing to obtainfromanyoutsideorganizationall mannerof consumerreportsand investigativeconsumerreportsnow and, if you are hired,throughoutthecourseof youremploymentto theextentpermittedbylaw. Asa result,youshouldcarefullyconsiderwhetherto exerciseyourrightto requestdisclosureof thenatureandscopeof anyinvestigativeconsumerreport.
NewYorkapplicantsor emploveesonlv:
YouhavetherighttoinspectandreceiveacopyofanyinvestigativeconsumerreportrequestedbytheEmployerbycontactingAdvancedSurveillanceGroupdirectly.
ACKNOWLEDGMENT AND AUTHORIZATION
I acknowledgereceipt of the NOTICEREGARDINGBACKGROUNDINVESTIGATIONand A SUMMARYOF YOURRIGHTSUNDERTHEFAIRCREDITREPORTINGACTandcertifythatI havereadandunderstandbothof thosedocuments.I herebyauthorizethe obtainingof "consumerreports"and/or"investigativeconsumerreports"at anytimeafterreceiptof thisauthorizationand,if I amhired,throughoutmyemployment.To thisend,I herebyauthorize,withoutreservation,any law enforcementagency,administrator,state or federalagency,institution,schooloruniversity(publicor private),informationservicebureau,employer,or insurancecompanyto furnishany and allbackgroundinformationrequestedbyAdvancedSurveillanceGroup,anotheroutsideorganizationactingonbehalfof itself. I agreethata facsimile("fax")or photographiccopyof thisAuthorizationshallbeasvalidastheoriginal.
Minnesota and Oklahoma applicants or employees only:Pleasecheckthis box if you would like to receivea copyof a consumerreportif one is obtainedby theCompany.o I would like to receivea co
Californiaapplicantsor employeesonly:Bysigningbelow,youalsoacknowledgereceiptoftheNOTICEREGARDINGBACKGROUNDINVESTIGATIONPURSUANTTOCALIFORNIALAW.Pleasecheckthisboxif youwouldliketo receiveacopyofaninvestigativeconsumerreportor consumercreditreportif oneisobtainedbytheCompanyatnochargewheneveryouhavea rightto receivesucha copyunderCalifornialaw.o I wouldliketo receivea copyofmyconsumerreport
Applicant Initial here:,
Page1of 2
888-677-9700
ADVANCEDSURVEILLANCEGROUP,INC.UcensedPrivateDetectives
Fax: 866.783-3939
- -- --------
Licensed Private Detectives
BACKGROUNDINFORMAT10N
The following is for identification purposes only and is necessary to perform the background check. It willnot be used for any other purpose. (Please print clearly)
Part 1
Printed Name (Last, First, Middle)
Maiden Names Used Date Changed
Drivers License Number and Issuing StateSocialSecurityNumber(xxx-xx-xxxx)
Date of Birth (mm/dd/yyyy)
Complete Current Address (No P.O Boxes) County, State, Zip Code
County, State, Zip CodeLast Previous Address (No P,O Boxes)
Part 2
Highest Degree of Education (College/Technical School/High School etc...) YearGraduated LastNameat Graduation
City,State
Last Employer/Current Employer City, State, lip Phone Dates of Employment
Previous Employer City, State, lip Phone Dates of Employment
Previous Employer City, State, lip Phone Dates of Employment
Signature DatePage2of 2
ADVANCEDSURVEILLANCEGROUP,INC.UcensedPrivateDetectives
888-677-9700 Fax:866-783-3939
- - - - - ---- - - -
ADVANCED SURVEILLANCE GROUp, INC.
Licensed Private Detectives40 Macomb Place Ste. 201
Mt. Clemens, MI48043888.677.9700
EmPloyee Background ScreeningConditions of Use Agreemen~
Pursuant to the provisions set forth by the Fair Credit ReportingAct (FCRA) of
2003, all employers must be notified by their third party consumer reporting
agencies(CRA) of the following:
. The purpose of the information to be provided to the employer is to be
used for employment or placing only.
. The employer is not to use the information provided in violation of any
state or federal equal opportunity laws.
. Employer must take every step necessary to obtain the necessary
disclosures and consents as required by the FCRA.
. Employer must give notice to the CRA in the event that adverse action is
taken against an applicant based upon the consumer report provided.
Please acknowledge that you have read the above and understand and agreeto these conditions of use of our services. We ask that an authorizedrepresentative of your company sign and return the original copy for ourrecords.
Company Name
Representative Signature
Date
40 MacombPlace,Suite201,Mt.Clemens,MI48043 888-677-9700 Fax 866-783-3939
- - - - - - - - - - - - - --
LicensedPrivateDetectives
Parainformationen espanol,visitewww.ftc.Qov/credit0 escribea la FTCConsumerResponseCenter,Room130-A 600PennsylvaniaAve.N. W.,Washington,D.C.20580.
A Summaryof Your RiQhtsUnderthe Fair CreditReportinQAct
ThefederalFairCreditReportingAct(FCRA)promotestheaccuracy,faimess,andprivacyof informationinthefilesofconsumerreportingagencies.Therearemanytypesofconsumerreportingagencies,includingcreditbureausandspecialtyagencies(suchasagenciesthatsellinformationaboutcheckwritinghistories,medicalrecords,andrentalhistoryrecords).Hereis asummaryofyourmajorrightsundertheFCRA.For moreinformation,including informationaboutadditionalrights, goto www.ftc.Qov/creditor write to: ConsumerResponseCenter,Room130.A,FederalTradeCommission,600PennsylvaniaAve.N.W.,Washington,D.C.20580.
You must betold if informationin your file has beenusedagainstyou. Anyonewhousesacreditreportoranothertypeofconsumerreporttodenyyourapplicationforcredit,insurance,oremployment-or to takeanotheradverse action against you -must tell you, and must give you the name, address, and phone number of the agencythatprovidedtheinformation.
You havethe right to knowwhat is in your file. Youmayrequestandobtainalltheinformationaboutyouin thefilesofa consumerreportingagency(your"filedisclosure").Youwillberequiredtoprovideproperidentification,whichmayincludeyourSocialSecuritynumber.Inmanycases,thedisclosurewillbefree. Youareentitledto a freefiledisclosureif:
a personhastakenadverseactionagainstyoubecauseof informationinyourcreditreport;youarethevictimof identifytheftandplaceafraudalertinyourfile;yourfilecontainsinaccurateinformationasa resultof fraud;youareon publicassistance;youareunemployedbutexpectto applyforemploymentwithin60days.
Inaddition,bySeptember2005allconsumerswillbeentitledto onefreedisclosureevery12monthsuponrequestfromeachnationwidecreditbureauandfromnationwidespecialtyconsumerreportingagencies.Seewww.ftc.Qov/creditforadditionalinformation.
You havethe right to askfor a credit score. Creditscoresarenumericalsummariesof yourcredit-worthinessbasedoninformationfromcreditbureaus.Youmayrequestacreditscorefromconsumerreportingagenciesthatcreatescoresordistributescoresusedin residentialrealpropertyloans,butyouwillhaveto payfor it. Insomemortgagetransactions,youwillreceivecreditscoreinformationfor freefromthemortgagelender.
You havethe right to dispute incompleteor inaccurateinformation. If youidentifyinformationinyourfilethat isincompleteor inaccurate,andreportit to theconsumerreportingagency,theagencymustinvestigateunlessyourdisputeis frivolous.Seewww.ftc.Qov/creditfor anexplanationofdisputeprocedures.
Consumerreportingagenciesmustcorrect or deleteinaccurate,incomplete,or unverifiableinformation.Inaccurate,incompleteorunverifiableinformationmustberemovedorcorrected,usuallywithin30days. However,aconsumerreportingagencymaycontinueto reportinformationit hasverifiedasaccurate.
Consumerreportingagenciesmaynot reportoutdatednegativeinformation. Inmostcases,a consumerreportingagencymaynotreportnegativeinformationthatismorethansevenyearsold,orbankruptciesthataremorethan10yearsold.
Access to your file is limited. A consumerreportingagencymayprovideinformationaboutyouonlytopeoplewithavalid need - usually to consider an application with a creditor, insurer, employer, landlord, or other business. TheFCRAspecifiesthosewithavalidneedforaccess.
ADVANCEDSURVEILLANCEGROUP,INC.UcensedPrivateDetectives
888-677-9700 Fax: 866-783-3939
--- - ----
Licensed Private Detectives
You must give your consent for reports to be provided to employers. A consumer reporting agency may not give
out information about you to your employer, or a potential employer, without your written consent given to the
employer. Written consent generally is not required in the trucking industry. For more information, go towww.ftc.Qov/credit.
You may limit "prescreened" offers of credit and insurance you get based on information in your credit report.Unsolicited .prescreened" offers for credit and insurance must include a toll-free phone number you can call if youchoose to remove your name and address from the lists these offers are based on. You may opt-out with thenationwide credit bureaus at 888-5-0PT-OUT (888-567-8688)or www.optoutprescreen.com.
You mayseekdamagesfrom violators. If a consumerreportingagency,or, insomecases,auserof consumerreportsor a furnisherof informationto aconsumerreportingagencyviolatestheFCRA,youmaybeabletosueinstateor federalcourt.
Identity theft victims and active duty military personnel have additional rights. For more information, visitwww.ftc.Qov/credit.
States may enforce the FCRA, and manystates havetheirownconsumerreportinglaws. Insome cases, you mayhavemore rights under state law. For more information, contact your state or local consumer protection agency or yourstate Attorney General Federal enforcers are:
ADVANCEDSURVEILLANCEGROUP,INC.UcensedPrivateDetectives
888-677-9700 Fax: 866-783-3939
----- - - -
TYPE OF BUSINESS: CONTACT:
Consumer reporting agencies, creditors and others not listed below Federal Trade Commission: Consumer Response Center - FCRAWashington, DC 20580 1-877-382-4357
National banks, federal branches/agencies of foreign banks (word Office of the Comptroller of the Currency"National" or initials "NA" appear in or after bank's name) Compliance Management, Mail Stop 6-6
Washington, DC 20219 800-613-6743Federal Reserve System member banks (except national banks, Federal Reserve Boardand federal branches/agencies of foreign banks) Division of Consumer & Community Affairs
Washington, DC 20551 202-452-3693
Savings associations and federally chartered savings banks (word Office of Thrift Supervision"Federal" or initials "F.S.B: appear in federal institution's name) Consumer Complaints
Washington, DC 20552 800-842-6929Federal credit unions (words "Federal Credit Union" appear in National Credit Union Administrationinstitution's name) 1775 Duke Street
Alexandria, VA 22314 703-519-4600State-chartered banks that are not members of the Federal Reserve Federal Deposit Insurance CorporationSystem Consumer Response Center, 2345 Grand Avenue, Suite 100
Kansas City, Missouri 64108-2638 1-877-275-3342Air, surface, or rail common carriers regulated by former Civil Department of Transportation, Office of Financial ManagementAeronautics Board or Interstate Commerce Commission Washinaton, DC 20590 202-366-1306
Activities subject to the Packers and Stockyards Act, 1921 Department of Agriculture Office of Deputy Administrator - GIPSAWashington, DC 20250 202-720-7051