Online Background Check Release Form

Empower Employs Online Authorization to Obtain Consumer Report and for Continuous Monitoring Form

Background Check, Consumer Report, Continuous Monitoring Disclosure

In connection with your employment application or other [business / employment / tenant] purpose, Empower Employs, LLC (herein known as “THE COMPANY”), will seek background information about you from a consumer reporting agency. This information may be in the form of both consumer reports and investigative consumer reports.
These reports may be obtained at any time after “THE COMPANY” receives authorization from you, [including any time during your business relationship or the period of your employment if “THE COMPANY” hires you] and may be ongoing or continuous in nature.
Consumer reports include any written, oral, or other communication of information by a consumer reporting agency bearing on your credit standing, character, general reputation and other characteristics that is expected to be used for [business / employment / tenant] purposes. Consumer reports may include credit reports, real property and personal property reports, criminal records, voter registration, education verification, and driving records (including Motor Vehicle Records, FMCSA PSP Records, DOT Drug Testing, DOT Pre-employment Verification and Identity Verification), among other resources.
Investigative consumer reports include similar information as consumer reports, as well as information related to your general reputation, personal characteristics, or mode of living, which is obtained through personal interviews with those who are acquainted with you or who may have knowledge of any relevant information about you.
ActiveTracks, or another consumer reporting agency, will obtain the reports for “THE COMPANY”. You have the right to request information from “THE COMPANY”, about the nature and scope of any investigative consumer report on you that is requested by “THE COMPANY”. The request must be made in writing and within a reasonable period of time after you have received this disclosure.
A summary of your rights under the federal Fair Credit Reporting Act (FCRA) is being provided to you with this disclosure. For more information about your rights under the FCRA, please go to www.consumerfinance.gov/learnmore. You are also being provided any applicable security freeze information.
New York Consumers – You have the right to inspect and receive a copy of any investigative consumer report by contacting the consumer reporting agency identified below directly. You may also contact Employer/Client to request the name, address and telephone number of the nearest unite of the consumer reporting agency designated to handle inquiries, which the Employer/Client shall provide within 5 days.
Notice to California Applicants. Under California law, the reports ordered about you for employment purposes within the State of California are defined as “investigative consumer reports.” These reports may contain information on your character, general reputation, personal characteristics and mode of living. Under California Civil Code § 1786.22, you may view the report(s) maintained at iiX during normal business hours. You also may obtain a copy by submitting proper identification and paying the cost of duplication by appearing at iiX in person, by mail, or by telephone. iiX is required to have personnel available to explain the report(s) and to explain any coded information. If you appear in person, you may be accompanied by a person of your choice, if s/he furnishes proper identification.
The consumer and/or investigative consumer report(s) will be obtained from:

ActiveTracks
949 Shady Grove, SUITE 401
MEMPHIS, TN 38120
(800) 311 – 6075

Note: Fields denoted with an * are required fields.

Your Full Name as shown on you DL or State ID

Current Address

Current City

Current State

Current Zip Code

Approx # of Years at Current Address

Home Phone

Mobile Phone

Your Date of Birth

DL or ID No.

State that issued DL or ID

Social Security Number

Previous Address #2

Previous City #2

Previous State #2

Previous Zip Code #2

Previous Address #3

Previous City #3

Previous Zip Code #3

Previous State #3

Acknowledge and Acceptance

By clicking send below, I acknowledge that I have received and read the Background Check, Consumer Report, Continuous Monitoring Disclosure, A Summary of Your Rights Under the Fair Credit Reporting Act and this authorization. I certify that I understand the documents I have received. I hereby authorize Empower Employs, LLC, its clients, or its authorized agents, for employment/business/leasing purposes, to obtain or prepare consumer reports and investigative consumer reports at any time after it receives this authorization. I understand that this reporting may be ongoing or continuous in nature during my employment. I hereby authorize law enforcement agencies, public and private schools, federal, state, and local agencies and courts, credit bureaus, information bureaus, current and former employers, financial institutions, licensing agencies, governmental agencies, the military, state motor vehicle departments, and other individuals and entities to provide any and all information that is requested by ActiveTracks, other consumer reporting agencies or Empower Employs, LLC. I certify that the information provided on this form is true and correct. I understand that any information that I provide may be used to obtain consumer reports and investigative consumer reports. Furthermore, I release and indemnify ActiveTracks and Empower Employs, LLC against any liability that might result from conducting such background checks.

Today's Date