DISCLOSURE AND AUTHORIZATION FORM TO OBTAIN CONSUMER
REPORTS FOR EMPLOYMENT PURPOSES
Please Read Carefully Before Signing the Authorization
DISCLOSURE
Collins Land Services, Inc. or its affiliates (“the Company”) may request
one or more consumer reports or investigative consumer reports about you for employment
purposes.
For explanation purposes, these reports may include information on your credit worthiness,
credit standing, credit capacity, character, general reputation, personal characteristics, or mode
of living which may be used as a factor in making an employment-related decision about you.
Such information may include, for example, credit information, criminal history reports, driving
records, or personal interviews with your prior employers, neighbors, friends, or associates, or
with others who may have knowledge concerning any such items of information.
If your employment falls under the federal Department of Transportation (“DOT”) and the
Federal Motor Carrier Safety Administration (“FMCSA”), including 49 CFR § 391.23, the report
could include your driving, safety inspection and performance history from the FMCSA.
The Company will obtain the consumer reports and investigative consumer reports from
Insurance Information Exchange dba IIX. IIX can be contacted by mail at 1574 Crescent
Pointe Pkwy, College Station, TX 77845; or phone: (800) 683-8553; or website: www.iix.com.
Under the provisions of the Fair Credit Reporting Act (“FCRA”), 15 U.S.C. § 1681 et seq.;
FMCSA regulations in the Federal Code of Regulations, including 49 CFR § 40.329; and certain
state laws, before we can seek such reports, where permitted, we must have your written
permission to obtain the information.
You have the right, upon written request, to a complete and accurate disclosure of the nature
and scope of the investigation. You also are entitled to a copy of that document entitled “Rights
Under the Fair Credit Reporting Act”. Under the FCRA, before we take adverse action on the
basis, in whole or in part, of information in a consumer report, you will be provided a copy of that
report, the name, address, and telephone number of the consumer reporting agency, and a
summary of your rights under the FCRA.
AUTHORIZATION
By signing below, I agree that have read and understand the foregoing Disclosure and authorize
the Company to obtain consumer reports or investigative consumer reports about me for
employment purposes and, if I am hired or I have already been hired, from time to time while I
am employed by Company without further authorization from me. I further authorize the
Company to share the information in the consumer reports and investigative consumer reports
with any person involved in the employment decision about me.
