Employment Application - Summer Camp Staff - Boy Scouts Of America Page 4
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4________________________ COUNCIL
BACKGROUND INVESTIGATION
DISCLOSURE AND AUTHORIZATION
For Use With ___________________ Council Employment Application
In making this application I understand that investigative reports, which may include information regarding
any criminal background, my creditworthiness, credit standing, credit capacity, character, general reputation,
personal characteristics, or mode of living, may be made. I authorize the ______________________ Council
to procure or cause to be procured such reports. Such a report may be a “consumer report” or an
“investigative consumer report” within the meaning of the Fair Credit Reporting Act (“FCRA”), in which
event I am entitled, upon my request in writing, to receive a complete and accurate disclosure of the
nature and scope of the investigation requested by the ______________________ Council and a summary
of my rights under the FCRA.
I also understand that under the FCRA, before taking any adverse employment action based in whole or
in part on a consumer report or investigative consumer report, the ______________________ Council must
provide me with a copy of the report and a written description of my rights under the FCRA. In addition,
if any adverse action is taken against me based in whole or in part on any information contained in a
consumer report, the ______________________ Council must give me a notice. The notice may be given
in writing, orally, or by electronic means and must include the following:
• The name, address, and telephone number of the consumer reporting agency (including
a toll-free telephone number established by the agency, if it is a nationwide consumer
reporting agency) that provided the report.
• A statement that the consumer reporting agency did not make the adverse decision and is
not able to explain why the decision was made.
• A statement setting forth my right to obtain a free disclosure of my file from the consumer
reporting agency if I request the report within 60 days.
• A statement setting forth my right to dispute directly with the consumer reporting agency the
accuracy or completeness of any information provided by the consumer reporting agency.
_____________________________________________________________
__________________________
Signature
Date
_____________________________________________________________
Printed Name
722-042
Page 4 of 4
2013 Printing
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