Evolution Consulting
Background Check Authorization/Disclosure For Research Associates Program

I. I, , understand that in conjunction with my application for employment, or if I am currently employed, in consideration of my promotion or reassignment, that Research Associates Program may request and rely upon an investigative consumer report on me that is obtained from a consumer reporting agency, which may include information about one or more of the following items: my character, general reputation, personal characteristics, mode of living, work habits, performance and experience, including employment eligibility for rehire, financial/credit history, criminal history records from any criminal justice agency or court in any or all federal, state, city and county jurisdictions, state Department of Motor Vehicle/Driver License Records to include traffic citations and registration, military records from the National Personnel Record Center, education records including transcripts and GPA, and requests for records and information from any individual, company, firm, corporation, present and/or past employers and public agencies (including the Social Security Administration and U.S. Citizenship and Immigration Services).

II. I hereby understand and authorize Research Associates Program to obtain and rely upon a consumer report generated on me after I have received a valid offer of employment or in consideration for promotion/reassignment. I acknowledge that to the extent an investigative consumer report is procured, I have the right to ask for a copy of the report; such request must be submitted to: Evolution Consulting, 49 Court Street, Suite 130, Binghamton, NY 13901 / info@evolutioncheck.com / phone: 1-833-207-0153 / website: https://evolutionexcellence.com. The report will be furnished to me upon proper identification. Those in California can request a copy of the report by checking the box in Section VIII below. Information regarding Evolution Consulting's privacy practices may be found at https://evolutionexcellence.com/privacy. I acknowledge that I have been informed of my rights under the Fair Credit Reporting Act as outlined by the Consumer Financial Protection Bureau in this summary: https://www.consumer.ftc.gov/articles/pdf-0096-fair-credit-reporting-act.pdf

III. I fully understand that Research Associates Program and /or its vendor Evolution Consulting LLC, may be requesting information from public and private sources about any of the information noted in Section [I], and I freely give my consent for Research Associates Program and Evolution Consulting LLC. to do so.

IV. I agree that a photocopy or telephonic facsimile of this authorization shall be as valid as the original with the same authority as the original.

V. I hereby authorize any one contacted by Research Associates Program and /or its vendor Evolution Consulting LLC., to furnish the information described in Section [I]. Information may be released to Research Associates Program and /or its vendor Evolution Consulting LLC, by telephone, facsimile or email.

VI. I hereby authorize Research Associates Program and / or its vendor, Evolution Consulting LLC, to contact my former employer/employers for employment verification/references and eligibility for rehire information.

VII. I agree that this disclosure further serves as a request that any present or former employer, police department, educational or financial institution, or other person having personal knowledge about me, to furnish Evolution Consulting LLC any and all information in its possession regarding me in connection with my application for employment.

VIII. California Applicants/Employees: By submitting this form, I acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. Link to document: Summary of your rights under CALIFORNIA CIVIL CODE §1786.22. I acknowledge that I can receive a copy of an investigative consumer report or consumer credit report at no charge if one is obtained by Evolution Consulting whenever I have a right to receive such a copy under California law by checking this box.

VIII A. San Francisco Applicants/Employees: By submitting this form, I acknowledge receipt of the San Francisco Fair Chance Ordinance - Official Notice to Job Applicants and Employees. Link to document: Fair Chance Ordinance

IX. New York Applicants/Employees: By submitting this form, I acknowledge receipt of a copy of the New York Correction Law Article 23-A. Link to document: NEW YORK CORRECTION LAW ARTICLE 23-A

X. Vermont Applicants/Employees: By submitting this form, I acknowledge receipt of a copy of Section 2480e of the Vermont Fair Credit Reporting Statute ("VFCRA"). Link to document: VFCRA

XI. Washington State Applicants/Employees: By submitting this form, I acknowledge receipt of A SUMMARY OF YOUR RIGHTS UNDER THE WASHINGTON FAIR CREDIT REPORTING ACT. Link to document: WFCRA

XII. Massachusetts, Minnesota, New Jersey and Oklahoma Applicants/Employees: By submitting this form, I acknowledge that I can receive a copy of an investigative consumer report or consumer report obtained on me at no charge if one is obtained by Evolution Consulting whenever I have a right to receive such a copy by state law by checking this box.

XIII. Oregon Applicants/Employees: By submitting this form, I acknowledge that information is available upon request regarding my rights under federal and Oregon laws regarding employment background checks.

APPLICANT: COMPLETE THE FOLLOWING

By my signature below, I hereby acknowledge the above and authorize Research Associates Program to obtain the investigative consumer reports described above about me.

  11/15/2018
Signed Today's Date

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