This Authorization, Waiver, and Release of Liability for Consumer Credit Report,
Employment Regulation and Policy is an agreement from the employer requesting that
the candidate for employment authorize and consent to the employer running a credit
check and obtaining a credit report regarding the candidate. The request indicates that
the credit report will be obtained in accordance with state (in this letter California is
used) and federal law. This form is ideal for small businesses who want to obtain
permission from their potential employees to conduct a credit check.
___________ [Instruction: Insert Company Name]
___________ [Instruction: Insert Company Address 1]
___________ [Instruction: Insert Company Address 2]
___________ [Instruction: Insert Date]
___________ [Instruction: Insert Applicant Name]
___________ [Instruction: Insert Address 1]
___________ [Instruction: Insert Address 2]
Re: Applicant Background Check/Credit Report
Dear ___________ [Instruction: Insert Applicant Name],
We at ___________ [Instruction: Insert Company Name], are glad that you have
applied for the position of ___________ [Instruction: Insert Position]. In connection with our
review of your application and in connection with our standard background check procedure, we
would like to run a credit report, in accordance with the provisions of the Fair Credit Reporting
Act, 15 U.S.C. §§1681 et seq. (“FCRA”) and the Consumer Credit Reporting Agencies Act, CA
Civil Code §1785 (“CCRAA”). A credit check is being requested because the position that you
are applying for is ___________ [Instruction: Insert Why Credit Check Can Legally be
Performed]. With your consent, the credit report will be performed by ___________
[Instruction: Insert Credit Report Company], www.___________.com [Instruction: Insert
web address of Credit Report Company]. Information in the credit report may be used to
make an adverse decision about your fitness for the position. You will be informed if any
information in your credit report leads to such an adverse decision. If you would like free a copy
of the credit report, please indicate so in the check box below. Your signature below indicates
that you have been advised of your rights under applicable law and consent to our hiring of
___________ [Instruction: Insert Credit Report Company] to perform a credit report.
Please confirm your acceptance to the foregoing terms by signing and returning this letter
to me no later than ___________ [Instruction: Insert Date]. Your signature indicates that you
agree to hold us and our officers, employees, or related personnel, harmless from any and all
liability for claims, liabilities, causes of action, damages, judgments, attorneys’ fees, court costs,
and expenses or damages of whatever kind, related to the exchange of such reasonable and
necessary information disclosed to us during the course of the employment background check,
screening process and credit report.
Very Truly Yours,
________________ [Instruction: sign]
___________ [Instruction: Insert Name of
Signatory],
___________ [Instruction: Insert Title]
I hereby accept each of the terms and conditions set forth in this letter regarding the employment
credit report.
________________________________
Signature of Candidate
___________
Date
By checking this checkbox, I further indicate that I would like a free copy of the credit
report run performed by ___________ [Instruction: Insert Credit Report Company].
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