Background Check Certified Agent Background Check Disclosure and Authorization Form Application Details Company Name Certified Artist LLC Position Applied For Certified Agent Date of Application 1. Background Investigation Disclosure Certified Artist LLC may obtain consumer reports for employment purposes including character reputation employment history education verification licenses driving records references and credit history where legally permitted. Criminal history records federal state local Employment verification Education verification Professional license checks Driving records Reference checks Credit history only where legally permitted 2. State Specific Notices Select any state notice copy request that applies. California Request copy of report Minnesota Request copy of report Oklahoma Request copy of report 3. Authorization I authorize Certified Artist LLC to obtain consumer reports and investigative reports during employment and for hiring purposes. I release all parties from liability for providing information. I authorize Certified Artist LLC to obtain background check reports for hiring and employment purposes. I confirm that the information provided in this form is true and accurate. 4. Applicant Rights FCRA Be informed of adverse information usage Access your consumer file Dispute incorrect data Obtain free reports under conditions I confirm that I have read and understand my applicant rights under FCRA. Applicant Information Full Legal Name Other Names Used Date of Birth SSN Last 4 Digits Current Address Previous Addresses Last 7 Years Phone Number Email Address Applicant Signature Signature Date Printed Name 5. Electronic Signature Agreement I agree that my typed name serves as my signature. Submit Authorization
