In connection with your application for employment, Security Research, Inc. may procure a consumer report on you as part of a process of considering your candidacy as an employee which may contain public record information. Such reports may contain information concerning your driving record, workers compensation claims, credit, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records. In the event that information from the report is utilized in whole or in part in making an adverse decision with regard to your potential employment, before making the adverse decision, we will provide you with a copy of the consumer report and a description in writing of your rights under the Federal Fair Credit Reporting Act.

The Fair Credit Reporting Act gives you specific rights in dealing with consumer reporting agencies. You will be given a summary of these rights together with this document.

I hereby authorize Security Research Inc. and its agents to obtain a consumer report and investigate my background as it pertains to my application for employment. I release such persons and sources from any liability or damages on account of having furnished such information.

Applicant's Full Name
Applicant's Street Address
City			State		Zip Code
Social Security Number
Date of Birth
Driver's License Number			State

I agree
By checking this box you authorize Security Research Inc. and its agents to obtain a consumer report and investigate my background as it pertains to my application for employment. I release such persons and sources from any liability or damages on account of having furnished such information