Fair Credit Reporting Act (FCRA) Disclosure – For Volunteers

Fair Credit Reporting Act (FCRA) Disclosure – For Volunteers As a volunteer applicant for the Diocese of Colorado Springs or one of its related entities, or if you are accepted, and decisions are made about your continuing involvement, the employer may conduct an investigation of your background. The consumer report that the diocesan entity may obtain could include information about criminal history records, motor vehicle records, educational verification, and other investigative consumer reports. In the case of those handling money or diocese/parish/school assets, it may also include credit history. I have rights as noted in “A Summary of Your Rights under the Fair Credit Reporting Act” which will be provided to me. If the diocesan entity intends to take any adverse action based on information contained in the consumer report, I will be provided with a copy of the report, before the diocesan entity finalizes the decision. To assist in obtaining a consumer report, please provide the following information: Print name ___________________________________________________________________________________________ First Middle Last Maiden/Other Alias Street Address ________________________________________________________________________________________ ____________________________________________________________________________________________________ City State Zip Code County ___________________________ ____________________ ______________ __________________________________ Social Security Number Date of Birth Gender E-mail address ___________________________________________ Driver’s License Number ___________________________________ How long since Maiden/Alias Name Used?

_________________ State Issued __________________________________________ Daytime Telephone Number

____________________________________________ Signature

__________________________________ Date

___________________________________________________________________________________ If you have resided in Colorado less than 7 years, please list addresses for the last 7 years. (Use extra paper if needed.) ____________________________________________________________________________________________________ Street Address/PO Box _________________________________________________________________ City State Zip Code

____________________________ From (date) To (date)

____________________________________________________________________________________________________ Street Address/PO Box _________________________________________________________________ City State Zip Code

____________________________ From (date) To (date)

____________________________________________________________________________________________________ Street Address/PO Box _________________________________________________________________ City State Zip Code

____________________________ From (date) To (date)

Fair Credit Reporting Act (FCRA) Authorization – For Volunteers I voluntarily authorize the Diocese of Colorado Springs or one of its related entities to obtain criminal history records, motor vehicle records, and other investigative consumer reports about me in order to make informed decisions regarding my proposed or actual volunteer relationship with the Diocese of Colorado Springs or one of its related entities, from a consumer reporting agency. I acknowledge that I have rights under the Fair Credit Reporting Act including those discussed in “A Summary of Your Rights under the Fair Credit Reporting Act” which will be provided to me. I further authorize any person, business entity or governmental agency who may have information relevant to the above to disclose this to the consumer reporting agency being utilized by the diocesan entity, including but not limited to current and former employers and supervisors, credit reporting agencies, law enforcement agencies, educational institutions, motor vehicle departments, municipal, county, state and federal courts to release this information to the organization through the consumer reporting agency being utilized.

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Printed Name (with middle name or initial)

Date

_______________________________________________ Signature

Version 2016-10-28