Disclosure and authorization form for employment purposes

Please Read Carefully Before Signing the Authorization

DISCLOSURE

In considering you for employment and, if you are employed, in considering you for subsequent promotion, assignment, reassignment, retention, or discipline, RD Expedited (“the Company”) may request and rely upon one or more consumer reports or investigative consumer reports, consisting of motor vehicle records, about you that we obtain from Explore Information Services, LLC, a consumer reporting agency.

Definitions used in this authorization form:

  • a “consumer report” is a written, oral or other communication of any information by a consumer reporting agency bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in making an employment-related decision about you. Such information may include, for example, credit information, criminal history reports, or driving records; and
  • an “investigative consumer report” is a consumer report in which information on your character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with your prior employers, neighbors, friends, or associates, or with others who may have knowledge concerning any such items of information. In the event an investigative consumer report is requested about you, you are entitled to additional disclosures regarding the nature and scope of the investigation requested, as well as a written summary of your rights under the Fair Credit Reporting Act (“FCRA”).

Under the FCRA, before RD Expedited can obtain a consumer report or investigative consumer report about you for employment purposes, we must have your written authorization. Before we take adverse action on the basis, in whole or in part, of information in that report, you will be provided a copy of that report, the name, address, and telephone number of the consumer reporting agency that provided such report to Company, and a summary of your rights under the FCRA.

RD Expedited will monitor your driving record and license status on an ongoing basis during your employment, membership, or contract period with the Company.

AUTHORIZATION

I have read and understand the foregoing Disclosure, and authorize RD Expedited to obtain and rely upon consumer reports or investigative consumer reports, obtained from Explore Information Services, LLC, consisting of motor vehicle records, and as an employee of the Company, in considering me for subsequent promotion, assignment, reassignment, retention, or discipline. By my signature below, I authorize RD Expedited to obtain any such motor vehicle records and to share the information received with any person involved in the employment decision about me. This authorization shall serve as an ongoing authorization to procure consumer report information, including motor vehicle records, on an ongoing basis during my employment, until termination of the contract period with RD Expedited.

I also agree that this Disclosure and Authorization in original, faxed, photocopied, or electronic (including electronically signed) form will be valid for any consumer reports or investigative consumer reports, consisting of motor vehicle records, that RD Expedited may request about me directly or through Explore Information Services, LLC.

I certify that all elements of the personal data I have provided are true, accurate, and complete. I understand and agree that any omission, false statement, misleading statement, or answer made by me on my application or any supplements to it and in any interviews will be sufficient grounds for rejection of employment and my discharge after employment.

PERSONAL DATA (Please print clearly)

To help us identify you, please provide us with the following information:

After Signig this document you will redirect to “WRITTEN CONSENT FOR CDLIS INQUIRY” document
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