Candidate Disclosure

Candidate Disclosure, Authorization & Consent for the Procurement of Consumer Reports

Section I: Disclosure

Accident Care and Treatment Center (the “Company”) may request background information about you from a consumer reporting agency in connection with your employment application and for employment purposes. The report ordered is defined by the Fair Credit Reporting Act (FCRA) as a Consumer Report, and all inquiries are limited to information that affects job performance and the workplace. It is conducted in accordance with applicable federal and state laws including the FCRA.  The screening will be conducted by an outside agency: Inflection Risk Solutions, LLC d/ b/a GoodHire – Address: P.O. Box 391403 Omaha, NE 68139 | Phone: 1- 888-906- 7351 | Fax: 650-362-1933 | Email: As a result, GoodHire may obtain a Consumer Report on you as an applicant or during employment.

A consumer report is a compilation of information that might affect your employability. The report may include information on your character, general reputation, personal characteristics, and mode of living. The scope of the report may include information concerning your driving record, civil and criminal court records, credit, drug screening results, worker’s compensation record, education, credentials, identity, past addresses, social security number, previous employment and personal references.

Section II: Authorization and Release

I have carefully read and understand this Candidate Disclosure, Authorization & Consent for the Procurement of Consumer Reports form and the attached summary of rights under the Fair Credit Reporting Act. By my signature below, I authorize the Company to share the contents of this consumer report or investigative consumer report with its partners and clients in an effort to place me into an employment/independent contractor relationship with those partners. The Company will only share the background report as necessary in order to assign me to a client, partner company, or organization. I understand that if the Company hires me, my consent will apply, and the Company may obtain reports, throughout my employment. I also understand that information contained in my job application or otherwise disclosed by me before or during my employment, if any, may be used for the purpose of obtaining consumer reports and/or investigative consumer reports. By my signature below, I authorize law enforcement agencies, learning institutions (including public and private schools and universities), information service bureaus, credit bureaus, record/data repositories, courts (federal, state and local), motor vehicle records agencies, my past or present employers, the military, and other individuals and sources to furnish any and all information on me that is requested by the consumer reporting agency. By my signature below, I certify the information I provided on this form is true and correct and will be valid for any reports that may be requested by or on behalf of the Company.

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Para información en español, visite o escribe a la Consumer Financial Protection  Bureau, 1700 G Street N.W., Washington, DC 20552. 

The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of  consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty  agencies (such as agencies that sell information about check writing histories, medical records, and rental history records).  Here is a summary of your major rights under the FCRA. For more information, including information about additional  rights, go to or write to: Consumer Financial Protection Bureau, 1700 G Street  N.W., Washington, DC 20552. 

  • You must be told if information in your file has been used against you. Anyone who uses a credit report or another  type of consumer report to deny your application for credit, insurance, or employment – or to take another adverse  action against you – must tell you, and must give you the name, address, and phone number of the agency that provided  the information. 
  • You have the right to know what is in your file. You may request and obtain all the information about you in the files of  a consumer reporting agency (your “file disclosure”). You will be required to provide proper identification, which may  include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if: 
  • a person has taken adverse action against you because of information in your credit report; you are the victim of identity theft and place a fraud alert in your file; 
  • your file contains inaccurate information as a result of fraud; 
  • you are on public assistance; 
  • you are unemployed but expect to apply for employment within 60 days. 

In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit  bureau and from nationwide specialty consumer reporting agencies. See for  additional information. 

  • You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on  information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores  or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions  you will receive credit score information for free from the mortgage lender. 
  • You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is  incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your  dispute is frivolous. See for an explanation of dispute procedures.  
  • Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete, or unverifiable information must be removed or corrected, usually within 30 days. However, a  consumer reporting agency may continue to report information it has verified as accurate. 
  • Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting  agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10  years old.
  • Access to your file is limited. A consumer reporting agency may provide information about you only to people with a  valid need -- usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA  specifies those with a valid need for access. 
  • You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out  information about you to your employer, or a potential employer, without your written consent given to the employer.  Written consent generally is not required in the trucking industry. For more information, go to
  • You many limit “prescreened” offers of credit and insurance you get based on information in your credit report.  Unsolicited “prescreened” offers for credit and insurance must include a toll-free phone number you can call if you  choose to remove your name and address from the lists these offers are based on. You may opt out with the nationwide  credit bureaus at 1-888-5-OPTOUT (1-888-567-8688). 
  • You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports  or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or  federal court. 
  • Identity theft victims and active duty military personnel have additional rights. For more information, visit

States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have  more rights under state law. For more information, contact your state or local consumer protection agency or your  state Attorney General. For information about your federal rights, contact:



1.a. Banks, savings associations, and credit unions with total  assets of over $10 billion and their affiliates 

b. Such affiliates that are not banks, savings associations,  or credit unions also should list, in addition to the CFPB:

Consumer Financial Protection Bureau 1700 G 

Street, N.W.  

Washington, DC 20552 

Federal Trade Commission  

Consumer Response Center 600  

Pennsylvania Avenue, N.W. 

Washington, DC 20580  

(877) 382-4357

2. To the extent not included in item 1 above: 

a. National banks, federal savings associations, and  federal branches and federal agencies of foreign banks 

b. State member banks, branches and agencies of  foreign banks (other than federal branches, federal  agencies, and Insured State Branches of Foreign Banks),  commercial lending companies owned or controlled by  foreign banks, and organizations operating under section  25 or 25A of the Federal Reserve Act 

c. Nonmember Insured Banks, Insured State  Branches of Foreign Banks, and insured state savings  associations 

d. Federal Credit Unions

a. Office of the Comptroller of the Currency Customer Assistance Group 

1301 McKinney Street, Suite 3450 

Houston, TX 77010-9050 

b. Federal Reserve Consumer Help Center P.O. Box. 1200 Minneapolis, MN 55480 

c. FDIC Consumer Response Center 1100 Walnut  Street, 

Box #11 Kansas City, MO 64106 

d. National Credit Union Administration Office of  Consumer Protection (OCP) Division of Consumer Compliance and Outreach (DCCO) 

1775 Duke Street 

Alexandria, VA 22314

3. Air carriers 

Asst. General Counsel for Aviation Enforcement &  Proceedings  

Aviation Consumer Protection Division Department of  Transportation  

1200 New Jersey Avenue, S.E. Washington, DC 20590 

4. Creditors Subject to the Surface Transportation Board

Office of Proceedings, Surface Transportation Board  Department of Transportation 395 E Street, S.W.  Washington, DC 20423 

5. Creditors Subject to the Packers and Stockyards Act, 1921

Nearest Packers and Stockyards Administration area  supervisor 

6. Small Business Investment Companies 

Associate Deputy Administrator for Capital Access  United States Small Business Administration 409 Third th  Street, S.W., 8 Floor Washington, DC 20416 

7. Brokers and Dealers 

Securities and Exchange Commission 100 F Street, N.E.  Washington, DC 20549 

8. Federal Land Banks, Federal Land Bank Associations, Federal Intermediate Credit Banks, and Production Credit Associations

Farm Credit Administration 1501 Farm Credit Drive  McLean, VA 22102-5090 

9. Retailers, Finance Companies, and All Other Creditors Not Listed Above

Federal Trade Commission  

Consumer Response Center 600  

Pennsylvania Avenue, N.W. 

Washington, DC 20580 

(877) 382-4357

Consumers Have The Right To Obtain A Security Freeze 

Pursuant to Title III of the “Economic Growth, Regulatory Relief, and Consumer Protection Act” (PL No. 115-174), you have a  right to place a “security freeze” on your credit report, which will prohibit a consumer reporting agency from releasing  information in your credit report without your express authorization. The security freeze is designed to prevent credit, loans,  and services from being approved in your name without your consent. However, you should be aware that using a security  freeze to take control over who gets access to the personal and financial information in your credit report may delay,  interfere with, or prohibit the timely approval of any subsequent request or application you make regarding a new loan,  credit, mortgage, or any other account involving the extension of credit. 

As an alternative to a security freeze, you have the right to place an initial or extended fraud alert on your credit file at no  cost. An initial fraud alert is a 1-year alert that is placed on a consumer’s credit file. Upon seeing a fraud alert display on a  consumer’s credit file, a business is required to take steps to verify the consumer’s identity before extending new credit. If  you are a victim of identity theft, you are entitled to an extended fraud alert, which is a fraud alert lasting 7 years. 

A security freeze does not apply to a person or entity, or its affiliates, or collection agencies acting on behalf of the person or  entity, with which you have an existing account that requests information in your credit report for the purposes of reviewing  or collecting the account. Reviewing the account includes activities related to account maintenance, monitoring, credit line  increases, and account upgrades and enhancements. 

To place a security freeze or fraud alert on your credit report please contact the following consumer reporting agencies: 





State Law Disclosures  

If you reside in, or are seeking work in any of the following states, please review these additional notices:  

California: You have the right to view your file that a Consumer Reporting Agency holds. By providing proper  identification and duplication cost, you may obtain a copy of this information in person at the Consumer  Reporting Agency’s regular business hours and after providing reasonable notice for your request.  Additionally, you can make the same request via mail or over request a summary of the file over the phone.  The Consumer Reporting Agency can assist you in understanding your file, including coded information. You  are allowed to have one additional person accompany you so long as they provide proper identification.  

Maine: You have the right to ask and know whether a company ordered a background check on you. You can  request the name, address, and telephone number of the nearest Consumer Reporting Agency office. Your  request will be processed and sent to you in 5 business days.  

Minnesota: You have the right in most circumstances to submit a written request to the consumer reporting  agency for a complete and accurate disclosure of the nature and scope of any consumer report the Company  ordered about you. The consumer reporting agency must provide you with this disclosure within 5 days after  (i) its receipt of your request or (ii) the date the report was requested by the Company, whichever date is later. 

Massachusetts: You have the right to obtain a copy of any of your consumer reports that your company has  ordered on you by contacting the Consumer Reporting Agency for a free copy.  

New Jersey: You have the right to submit a request to the consumer reporting agency for a copy of any  investigative consumer report the Company requested about you.  

New York: By submitting a written request, you can learn whether a company has run a background check on  you. You are allowed to inspect and order a copy of the report by directly contacting the Consumer Reporting  Agency. If you have been convicted of one or more criminal offenses, you can request the company to provide  

a written statement declaring the reasons for the refusal of hire. This statement must be provided to you  within 30 days of your request.  

Washington State: After submitting a written request and waiting a reasonable amount of time after receiving  the disclosure, you have the right to receive a complete and accurate disclosure of the nature and scope of any  “investigative” consumer reports requested by an agency. The Washington Fair Credit Reporting Act requires  Consumer Reporting Agencies to provide you a summary of your rights and remedies upon request. Any  information requested by a company that deals with credit worthiness, credit standing or capacity is justified in  order for employers to evaluate whether you present a risk for theft or dishonest behavior for the job you are  being considered for.