Background Check Authorization

DISCLOSURE REGARDING BACKGROUND INVESTIGATION [Name of Company/Organization]: Senior Center Resources and Public Transit (SCRPT) In connection with your application for employment or volunteer service, [Company/Organization] (hereinafter "the Company") may obtain one or more consumer reports or investigative consumer reports about you for employment or volunteer purposes. These reports may include information about your character, general reputation, personal characteristics, and mode of living, and may include information about your criminal history, driving record, employment history, education history, and other background information. The reports will be prepared by Occuscreen, LLC, a consumer reporting agency. You may obtain a copy of Occuscreen's privacy policy at www.occuscreen.com. You may also obtain a free copy of any consumer report obtained about you by contacting Occuscreen within 60 days of the date of this disclosure. IMPORTANT NOTICE: This disclosure is made in accordance with the Fair Credit Reporting Act (FCRA), 15 U.S.C. § 1681 et seq. Under the FCRA, you have the right to know the information contained in your file at the consumer reporting agency. You have the right to dispute inaccurate information. Consumer reporting agencies are required to correct or delete inaccurate, incomplete, or unverifiable information. Consumer reporting agencies may not report outdated negative information. Access to your file is limited. You have the right to seek damages from violators. Identity theft victims and active duty military personnel have additional rights. This document is a stand-alone disclosure and may not be combined with any other document.

AUTHORIZATION FOR BACKGROUND INVESTIGATION I hereby authorize Senior Center Resources and Public Transit (SCRPT) and its designated agents and representatives to conduct a comprehensive review of my background through a consumer report and/or an investigative consumer report to be generated for employment or volunteer purposes. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: verification of Social Security number; current and previous residences; employment history, including all personnel files; education; references; credit history and reports; criminal history, including records from any criminal justice agency in any or all federal, state, or county jurisdictions; birth records; motor vehicle records, including traffic citations and registration; and any other public records. I authorize the complete release of these records or data pertaining to me that an individual, company, firm, corporation, or public agency may have. I hereby release SCRPT, the consumer reporting agency, and their agents, officials, representatives, or assigned agencies, including officers, employees, or related personnel, both individually and collectively, from any and all liability for damages of whatever kind, which may, at any time, result to me, my heirs, family, or associates because of compliance with this authorization and request to release information, or any attempt to comply with it. Should there be any questions as to the validity of this release, you may contact SCRPT at 903-454-1444. I acknowledge that a photocopy of this authorization shall be as valid as the original.