COMBINED DISCLOSURE NOTICE AND AUTHORIZATION
REGARDING BACKGROUND CONSUMER REPORTS
Important: Please read carefully before signing.
In connection with my application for employment (including a contract for services), I
understand that consumer reports or investigative consumer reports which may contain public
record information may be obtained on me including consumer credit, criminal records, driving
record, education, prior employer verification, workers compensation claims and others. These
reports may include experience information along with reasons for termination of past
employment. Said consumer report and/or an investigative consumer report may be obtained at
any time during the application process or during my employment with the employer. I
acknowledge that I have received the attached summary of my rights under the Fair Credit
I understand that I may, upon timely written request of the Client Services Department of the
Research Foundation of CUNY, and within 5 days of the request, receive the name, address and
phone number of the reporting agency and the nature and scope of the investigative consumer
report that will be obtained.
I understand that my offer of employment is contingent upon the results of the background
I also understand that before any adverse action is taken, based in whole or in part on the
information contained in the consumer report, I will be provided a copy of the report, the name,
address and telephone number of the reporting agency, and a summary of my rights under the
Fair Credit Reporting Act.
I hereby authorize and request, without any reservation, any present or former employer, school,
police department, financial institution, division of motor vehicles, consumer reporting agency,
court, department of corrections, or other person or agency having knowledge about me to furnish
the Research Foundation of CUNY, or its vendor(s) authorized for the purpose of performing