I, hereby give permission for Big
Brothers Big Sisters of Lubbock to investigate and obtain information related
to my criminal history record, employment history, educational background and
character references for the position for which I am applying. The criminal history record, as received from
various reporting outlets, may include arrest and conviction data, plea
bargains, deferred adjudications and delinquent conduct committed as a
juvenile. I understand that this
information will be used, in part to determine eligibility for all volunteer/employment
positions within this organization.
I further understand that Big
Brothers Big Sisters of Lubbock may utilize a professional agent or agencies to
assist in the gathering of this information, and I specifically authorize such
an investigation by the outside entities of the agency’s choice. I also understand that as long as I remain a volunteer
or employee, the criminal history records check may be repeated at any time
during my participation/employment with the agency. However, I may revoke my
authorization in writing at any time.
It is also understood that if I am
a suspect in a criminal investigation,
participate in a criminal activity, or have been arrested, convicted and/or
charged with a crime, I must inform Big Brothers Big Sisters of Lubbock
immediately. Failure to provide this information within 10 business days from
the incident may result in immediate dismissal from my position additionally,
information obtained from any background investigation may result in immediate
dismissal from any position.
I,
The undersigned, do, for myself, my heirs, executors and administrators, hereby
remise, release and forever discharge and agree to indemnify Big Brothers Big
Sisters of Lubbock and each of their officers, directors, employees and agent
and hold them harmless from and against any and all causes of actions, suits,
liabilities, costs, debt and sums of money, claims and demands whatsoever
(including claims for the negligence, gross negligence and or strict liability of
Big Brothers Big Sisters of Lubbock), and any and all related attorneys’ fees,
court costs and other expenses resulting from the investigation of my
background in connection with my application to become a volunteer and/or
employee.
Disclosure
Regarding Employment and/or Volunteer/Non-Employee Background Report
Big Brothers Big Sisters of Lubbock may obtain from Sterling
Volunteers, 4511 Rockside Road, 4th Floor,
Independence, OH 44131, 855-326-1820 Option 3, www.sterlingvolunteers.com, a consumer report (“REPORT”) that contains background information
about you in connection with your employment and/or volunteer/non-employee
position. If you are hired or on boarded in
a volunteer/non-employee position, to the extent permitted by law, Big Brothers Big Sisters of Lubbock may obtain from Sterling Volunteers further reports throughout your employment and/or volunteer/non-employee
position without providing further
disclosure or obtaining additional consent.
The
REPORT may contain information about your character, general reputation,
personal characteristics and mode of living. The REPORT may include, but is not
limited to, credit reports and credit history information; criminal and other
public records and history; public court records (e.g., bankruptcies, tax liens
and judgments); motor vehicle and driving records; educational and employment
history, including professional disciplinary actions; drug/alcohol test
results; and Social Security verification and address history, subject to any
limitations imposed by applicable federal and state law. This information may
be obtained from public record and private sources, including credit bureaus,
government agencies and judicial records, former employers and educational
institutions, and other sources.
Disclosure for Investigative Consumer
Report
Big Brothers Big Sisters of Lubbock may request an investigative consumer report about you from a third-party
consumer reporting agency, in connection with your employment and/or
volunteer/non-employee position and
throughout your employment and/or volunteer/non-employee position if you are
hired or onboarded as allowed by
law.
A consumer report is a background
report which may include but is not limited to, credit report, criminal
background, driving records, character, general reputation, personal
characteristics and mode of living.
An “investigative consumer report” is
a background report that includes information from personal interviews (except
in California, where that term includes background reports with or without
information obtained from personal interviews).
The most common form of an investigative consumer report in connection
with your employment and/or volunteer/non-employee position is a reference
check through personal interviews with sources such as your former employers
and associates, and other information sources.
The investigative consumer report may contain information concerning
your character, general reputation, personal characteristics, or mode of
living.
You have the right, upon written
request made within a reasonable time, to request from the Big Brothers Big Sisters of Lubbock (1) whether an investigative
consumer report has been obtained about you, (2) disclosure of the nature and
scope of any investigative consumer report and (3) a copy of your report. These reports will be prepared by Sterling Volunteers 4511 Rockside Road, 4th Floor, Independence, OH 44131,
855-326-1820 Option 3, www.sterlingvolunteers.com.
Authorization to Obtain Employment and/or Volunteer/Non-Employee Background
Report
I have
read the Disclosure Regarding Employment and/or Volunteer/Non-Employee
Background Report provided by Big Brothers Big Sisters of Lubbock ("the ORGANIZATION") and
this Authorization to Obtain Employment and/or Volunteer/Non-Employee Background
Report. By my signature below, I hereby consent to the preparation by Sterling
Volunteers, a consumer reporting agency
located at 4511 Rockside Road, 4th Floor, Independence,
OH 44131, 855-326-1820 Option 3, www.sterlingvolunteers.com, of background reports regarding me and the release
of such reports to the ORGANIZATION and its designated representatives, to
assist the ORGANIZATION in making an employment and/or
volunteer/non-employee position decision involving me at any time after
receipt of this authorization and throughout my employment and/or
volunteer/non-employee position, to the extent permitted by law. To this end, I
hereby authorize, without reservation, any state or federal law enforcement
agency or court, educational institution, motor vehicle record agency, credit
bureau or other information service bureau or data repository, or employer to
furnish any and all information regarding me to Sterling Volunteers and/or the ORGANIZATION
itself, and authorize Sterling Volunteers to provide such information to the ORGANIZATION.
I agree that a facsimile (“fax”), electronic or photographic copy of this
Authorization shall be as valid as the original.
I acknowledge
receipt of a copy of the Consumer Financial Protection Bureau’s “A SUMMARY OF
YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT.”
Select the link to view: A Summary of Your Rights Under the Fair Credit Reporting Act