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The Southern DNA

Consumer Report Disclosure – Waiver & Release

  • In connection with your employment or application for employment (including contract for services), consumer reports may be requested from US Investigations Services, LLC. ("USIS"). These reports may include the following types of information: names and dates of previous employers, reason for termination of employment, work experience, accidents, academic history, professional credentials, conversations with personal and/or business references, and drugs/alcohol use. Such reports may also contain public record information concerning your driving record, workers compensation claims, credit, bankruptcy proceedings, criminal reports, etc., from federal, state, and other agencies which maintain such records, as well as information from USIS concerning previous requests made by others from such state agencies and state provided driving records. You have the right to make a request to USIS, upon proper identification to release, the nature and substance of all information in its files on you at the time of your request, including the sources of information and the recipients of any reports on you that USIS has previously furnished within the two-year period preceding your request. USIS may be contacted by mail at P.O. Box 33181, Tulsa, Oklahoma, 74153, or by phone at (800) 381-0645.
  • I AUTHORIZE, WITHOUT RESERVATION, USIS, AND ANY PARTY OR AGENCY CONTACTED BY USIS, TO FURNISH THE ABOVE-MENTIONED INFORMATION.

    USIS is authorized to disclose all information obtained to the requesting entity for the purpose of making a determination as to my eligibility for employment, promotion or any other lawful purpose. I agree that such information which USIS has or obtains, and my employment history if I am hired, may be supplied by USIS. If hired or contracted, this authorization shall remain on file and shall serve as ongoing authorization for the procurement of future consumer reports, at any time, during my employment of contract period. By signing below, I certify that I have read and fully understand this release, that prior to signing I was given an opportunity to ask questions and to have those questions answered to my satisfaction, and that I executed this release voluntarily and with the knowledge that the information being released could affect my being hired, my employment, or my eligibility for promotion or transfer.
  • By typing your name here, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.
  • List previous addresses (for at least seven years):