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AG 2016 06 20
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AG 2016 06 20
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Last modified
6/22/2016 12:17:16 PM
Creation date
11/27/2017 10:33:31 AM
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Meeting Minutes
Doc Type
Agenda
Meeting Minutes - Date
6/20/2016
Board
Board of Commissioners
Meeting Type
Regular
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P Human Resources Department <br />* * P.O. Box 707 Concord, NC 28026 -0707 <br />Phone: 704.920.2200 . Fax' 704.920.2250 • www.cabarruscounty.us <br />iC.4 <br />Disclosure & Authorization for Release of Personal Information <br />(Personnel Records Are Maintained In Accordance With NCGS 153A -98) <br />- Please Print Clearly" <br />Return Completed Form to Human Resources <br />Full Name (First, Middle, Last): _ <br />List All Prior Names Used: <br />Date of Birth (Month, Day, Year): <br />Driver's License Number: <br />Social Security Number: <br />Street Address: <br />City /State /Zip; <br />Phone Number: { <br />DISCLOSURE -- NOTICE REGARDING BACKGROUND INVESTIGATION <br />Cabarrus County may obtain information about you from a consumer reporting agency for employment purposes. Thus, you may be <br />the subject of a "consumer report" and/or an "investigative consumer report" which may include information about your character, <br />general reputation, personal characteristics, and/or mode of living and which can involve personal interviews with sources such as <br />your neighbors, friends, or associates. These reports may be obtained at any time after receipt of your authorization and, if you are <br />hired, throughout your employment. You have the right, upon written request made within a reasonable time after receipt of this <br />notice, to request disclosure of the nature and scope of any investigative consumer report. Types of information that may be <br />obtained include but are not limited to social security number verification, sex offender registry cheeks, criminal records checks, <br />inmate records searches, motor vehicle retards, education, employment history, professional licenses, credit checks and court <br />records checks. The information contained in these consumer reports may be obtained by an outside organization from public <br />record sources and will not be used to discriminate against you in violation of any law. The scope of this Disclosure and <br />Authorization is all- encompassing, allowing Cabarrus County to obtain from any outside organization all manner of consumer reports <br />and Investigative consumer reports now and, if you are hired, throughout the course of your employment to the extent permitted by <br />law. <br />AUTHORIZATION AND ACKNOWLEDGMENT <br />I acknowledge receipt of the DISCLOSURE - NOTICE REGARDING BACKGROUND INVESTIGATION and "A SUMMARY OF YOUR RIGHTS <br />UNDER THE FAIR CREDIT REPORTING ACT" and certify that I have read and understand both of those documents.. <br />I hereby authorize the obtaining of "consumer reports" and/or "investigative consumer reports" at any time after receipt of this <br />authorization and, if I am hired, throughout my employment. To this end, I hereby authorize, without reservation, any law <br />enforcement agency, administrator, state or federal agency, military branch, institution, school or university (public or private), <br />information service bureau, past or present employer or supervisor, private business, insurance company or personal reference, <br />and/or other persons to furnish any and all background information requested by any third -parry organization acting on behalf of <br />Cabarrus County, and /or Cabarrus County itself. I agree that a facsimile ("fax") or photographic copy of this Authorization shall be as <br />valid as the original. <br />04/25/16 PDFConvert. 1073 1. 1. Section 1- Driver Employee_ Selection - Copy <br />State: DL Class (A, B. or C): <br />Attachment Iumber 1 \n <br />F -9 Page 190 <br />
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