does hereby certify the following:

When using the information for employment or contract purposes, we will:

• Disclose to the Applicant that a consumer report will be ordered
• Obtain written consent before ordering any reports
• Show the reports to the Applicant before denying the job or taking any other adverse action
• Provide the Applicant with the “Summary of Rights” notice
• Not violate any applicable Federal or State equal employment opportunity law or regulation

When refusing to hire someone based in whole or part on Security Research Inc. information we will:

• Notify the Applicant of the “adverse action”
• Provide to the Applicant the “Dear Applicant” information (sample attached)
• Notify the Applicant of the right to a free report and right to dispute the record (through Security Research Inc.)

Sign by typing in the boxes below:

Company Name		Date
Your Name		Date

I agree to abide by the Fair Credit Reporting Act as amended, effective September 30, 1997SubmitCancel