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CONSENT TO PROCUREMENT OF INVESTIGATIVE CONSUMER REPORT  

(Complete form below and click submit at bottom)

I understand that, as a condition of my consideration for employment with RJB CONTRACTING, or as a condition of my continued employment with RJB CONTRACTING, RJB CONTRACTING may obtain an investigative consumer report from CAREY CONSULTANTS, INC., that includes, but is not limited to, my criminal history, social security verification, DMV RECORDS and any other public records and any other information bearing on my character and general trustworthiness. They may also obtain DOT information if that is a necessary part of their employment screening process. I hereby authorize and consent to RJB CONTRACTING procuring a report from CAREY CONSULTANTS, INC., I understand that, pursuant to the FCRA, RJB CONTRACTING will provide me with a copy of any such report if the information contained in such report is considered to be adverse and would preclude RJB CONTRACTING from offering me the position or would negatively impact their decision regarding my fitness for employment, transfer or promotion within the company. I understand that RJB CONTRACTING has a right to re-check my background at anytime during my employment tenure or re-application process without further notification. I understand further that although this is a background form and NOT an employment application, if I provide any false or misleading information RJB CONTRACTING may immediately disqualify me for any position, transfer or promotion.

Digital Signature Release

A value is required.     Today's Date: A value is required.
Type Full Name - Equivalent to handwritten signature
(required)

 
Section I: Candidate DATA
Last name
 A value is required. (required)
First name
 A value is required. (required)
Middle Int
Date of Birth
 A value is required. (required)
Email Address
A value is required.   (required)
Social Security #
 A value is required. (required)
Alias Please indicate any other last names used & years they were utilized:
Street address
City
State/Zip
Home Phone
Have you been terminated from any place of employment within the past 7 years?
 Yes     No
If yes, indicated place of employment, cause for
discharge & month/year this termination took place:
Please list addresses for the past 10 years:
1.
2.
3.



Please list 3 PROFESSIONAL references (example; supervisors, professional colleagues, etc):
1st reference- Company
Relationship
Telephone
2nd reference- Company
Relationship
Telephone
3rd reference- Company
Relationship
Telephone
Section II: Driver's Information
Driver's License #
State issued
Has your license ever been revoked or suspended?
Yes     No

If yes, explain dates & Circumstances:

If you do not have a driver’s license, please explain why not:
Have you ever been convicted of a crime other than a minor traffic violation?
Yes     No
If yes, please explain, giving dates, locations & circumstances
Section III: Education
Please list the most recent school, college; professional school or trade school you attended:
Institution name & location
  
Degree/Yr earned:
  If you only attended & received no degree, please list dates of attendance:
Please indicate any further education you feel is relevant to the position for which you are applying:
Section IV: Military Experience
Branch
Rank
  
Dates
to
Did you receive an Honorable Discharge
 Yes     No
If not, please explain:
  
Please list any former last names & years used:
  
 
Special instructions or additional information you need searched:

 


(Empty Required Fields will display in RED)

By clicking the "Submit" you consent to terms stated above.





You will now be redirected to read the Fair Credit Reporting Act
(Please complete and submit to finish application)


 
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