Fair Credit Reporting Act Disclosure Statement


By this document, [Employer Name] discloses to you that a consumer report, including an investigative consumer report containing information as to your character, general reputation, personal characteristics and mode of living, may be obtained for employment purposes as part of the pre-employment background investigation and at any time during your employment. Should an investigative consumer report be requested, you will have the right to request a complete and accurate disclosure of the nature and scope of the investigation requested and a written summary of your rights under the Fair Credit Reporting Act. Please sign below to acknowledge the receipt of this disclosure.



__________________________________________            ________________________

Signature                                                                                        Date



Printed Name 


[Editor's Note:

In addition to the disclosure above, provide the individual with a copy of the Summary of Rights under the FCRA.

Separate authorization to conduct a background check is also required.] 



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