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  American Nanny Company >> Nannies and Caregivers >> Forms >> Information Release

US Information Search for American Nanny Company, Inc.
* Please make sure all information supplied is legible *


Background Check Disclosure

As part of the employment process, ________________________________________ hereby known as (“the company”), may obtain a consumer report and / or Investigative Consumer Report. The Fair Credit Reporting Act as amended by the Consumer Reporting Reform Act of 1996 requires that we advise you that for the purposes of employment only, a Consumer Report may be made which may include information about your credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. Upon written request, additional information as to the nature and scope of the report, if one is made, will be provided in the event the Report contains information regarding your character, general reputation, personal characteristics, or mode of living.

Authorization and Release

During the application process and at any time during any subsequent employment, I herby authorize U.S. Information Search on behalf of The Company to procure a Consumer Report which I understand may include information regarding my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. This report may include Criminal Records, Credit reports, Driving Records, Past Employment or Education Verifications, Worker’s Compensation Claims, and any other source required to verify information that I have voluntarily supplied. I understand that I may request a complete and accurate disclosure of the nature and scope of the background verification, to the extent such investigation includes information bearing on my character, general reputation, personal characteristics or mode of living. I authorize without reservation, any party or agency contacted to furnish the above mentioned information and release all parties involved from liability and responsibility for doing so. This authorization and consent shall be valid in original, fax, or copy form.

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Applicant / Employee Name & Date

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Applicant / Employee Signature & Birth Date

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Social Security Number

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Current Address

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Driver's License Number and State


______California and Minnesota Applicants Only: Please check here to have a copy of your consumer report sent to you from USIS. Mail a copy of this request with this box checked off to U.S. Information Search, 15 North Mill Street, Nyack, NY 10960. Include in the envelope a copy of your Driver's License (for identification) and a $5.00 check or money order (for processing) and an address where you would like the report mailed to.

______Oklahoma Applicants Only: Please check here to have a copy of your consumer report sent to you from USIS free of charge. Mail a copy of this request with this box checked off to U.S. Information Search, 15 North Mill Street, Nyack, NY 10960. Include in the envelope a copy of your Driver's License (for identification) and an address where you would like the report mailed to.



INSTRUCTIONS:

Please print this form, fill it out and send it back to the American Nanny Company using one of the following methods:
U.S. Mail:   American Nanny Company
or
Fax:   1-617-969-1269
    PO BOX 765 Newtonville Branch
    Boston, MA 02460

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