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(If less than 7 years, list previous address below)
(Complete as many blanks as apply to you.)
Please list the name, occupation and telephone numbers of three people (other than relatives) who know you well enough tho provide us with a reference.
(Employment Purposes) The City of Shreveport is required by law to provide the FCRA Summary of Rights with each background investigation. We utilize this investigation primarily for criminal background checks.
In connection with my application for employment, I understand that a consumer report and/or an investigative consumer report may be requested and obtained for employment purposes on behalf of the City of Shreveport. I also understand that, if I am hired, a consumer report and/or an investigative consumer report may be requested and obtained during the course of my employment.
The report may include information regarding my character, general reputation, personal characteristics, mode of living, and credit standing which may confirm or deny my eligibility for employment with the City of Shreveport. The information contained in the report will be obtained from private and public record sources, including, as may be appropriate, personal interviews with sources such as neighbors, friends and associates.
By providing the information requested in this for and singing this Disclosure Authorization, I authorize the City of Shreveport to request and obtain a consumer report and/or investigate consumer report regarding me. I also acknowledge that a facsimile or photographic copy of this Disclosure Authorization will be as valid as the original.
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