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Please Read Carefully Before Signing the Authorization TO (University of Toledo)

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Human Resources, Revised August 2015
College of Graduate Studies
The University of Toledo
Main Campus
2801 W. Bancroft St., MS # 933
Toledo, Ohio 43606
Phone (419) 530-
8582
DISCLOSURE AND AUTHORIZATION FORM
TO OBTAIN CONSUMER REPORTS FOR EMPLOYMENT PURPOSES
Please Read Carefully Before Signing the Authorization
DISCLOSURE
In considering you for employment and, if you are employed, in considering you for subsequent promotion,
assignment, reassignment, retention, or discipline, The University of Toledo may request and rely upon
one or more consumer reports or investigative consumer reports about you that we obtain from a
consumer reporting agency, such as IntelliCorp Records, Inc.
IntelliCorp Records, Inc. can be contacted by mail at 3000 Auburn Dr, Suite 410; Beachwood, OH 44122;
or phone: 1-888-946-8355; or website: www.intellicorp.net.
For explanation purposes:
x a “consumer report” is a written, oral or other communication of any information by a consumer
reporting agency bearing on your 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 making an employment-
related decision about you. Such information may include, for example, credit information, criminal
history reports, or driving records; and
x an “investigative consumer report” is a consumer report in which information on your character,
general reputation, personal characteristics, or mode of living is obtained through personal
interviews with your prior employers, neighbors, friends, or associates, or with others who may
have knowledge concerning any such items of information. In the event an investigative consumer
report is requested about you, you are entitled to additional disclosures regarding the nature and
scope of the investigation requested, as well as a written summary of your rights under the Fair
Credit Reporting Act (“FCRA”).
Under the FCRA, before the Company can obtain a consumer report or investigative consumer report
about you for employment purposes, we must have your written authorization. Before we take adverse
action on the basis, in whole or in part, of information in that report, you will be provided a copy of that
report, the name, address, and telephone number of the consumer reporting agency, and a summary of
your rights under the FCRA.
Human Resources, Revised August 2015
Co
llege of Graduate Studies
The University of Toledo
Main
Campus
2801 W. Bancroft St., MS #
933
Toledo, Ohio 43606
Phone (419) 530-
8582
AUTHORIZATION FORM
TO OBTAIN CONSUMER REPORTS FOR EMPLOYMENT PURPOSES
Please Read Carefully Before Signing the Authorization
I am a candidate for employment with the University of Toledo and hereby specifically authorize and permit the University of
Toledo and its principals, employees, agents, servants, and contractors to contact character references, former employers, law
enforcement agencies, courts of law, federal, state and local regulatory agencies, and schools to obtain information from such
sources about me. I understand that any investigation into my background may include reference to any information which is a
matter of public record (for example, criminal convictions, traffic offenses, and lawsuits). I further authorize the University of
Toledo to conduct pre-employment drug testing, physical examinations, and/or psychological examinations to determine my
suitability for employment, as required.
This release is executed with full knowledge and understanding that the information is for the official use of University of
Toledo. I understand that this form may be photocopied and sent to Police Departments, employers, etc., as deemed necessary
by Human Resources and the UT Campus Police Department. I further understand that information obtained from any job
related and behavioral tests will also be evaluated when making final hiring decisions.
Consent is also hereby granted to release requested information to the UT Campus Police Department.
I do
do not
authorize you to contact my current employer for Employment and Reference Verifications.
(This will authorize immediate inquiries to the Human Resources Department and to any listed supervisors or
references in the Employment/Reference Section of your application.)
I also agree that this Disclosure and Authorization in original, faxed, photocopied, or electronic (including
electronically signed) form will be valid for any consumer reports or investigative consumer reports that may be
requested about me by or on behalf of the Company.
I understand that in signing this release I will be authorizing
the University of Toledo
to make inquiries into my personal,
educational and work history. I also understand that a conditional offer of employment may be withdrawn based on the
information obtained in such inquiries and tests, and also based upon the results of a pre
-employ
ment drug screen, physical
examination and/or psychological examination, or driving record, if required.
Pri
nt Full Name: __________________________________________________ SSN: _______-_____-_________
First Middle Last
Previous Names Used: ___________________________________________ Gender: Male
Female
Date of Birth (MM/DD/YYYY): _______/_______/____
____ T
elephone #: (______) ________ - __________
Current Street Address (No P.O. Box Please): _________________________________________________________
City/State/Zip: County __________________
Previous Cities/Towns, State(s) lived in: _______________________________________________________________
Email Address: ____________________________________ Job Title: _____________
SIGNATURE: ________________________________________ Date: _______________________________
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Completed 31 August 2020

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