Screening

Employment Screening Sign Up Request Form

We do not charge sign up fees, maintenance fees or per location fees and there are no monthly minimums.

You pay for only the reports you order.

New Client Information

Please Fax Completed Document to 813.886.2610

Company Name:_____________________________________________________

Company Representative (L,F,M):_______________________________________

Title: ____________________________________

Employer Federal ID#, Tax ID#: ________________________________________

Street Address: ____________________________________________________

City, State & Zip: ____________________________________________________

Email: ____________________________Phone:___________________________

Fax#: _____________________________

Billing Address (if Different from Above):_________________________________

Types Of Searches Required: Criminal Background Checks, Workers' Comp Claims History, Motor Vehicle Records: (MVRS), Social Security Number Trace,Civil Court Records, Credit Reports, Drug Testing,Employer Reference verification:

Other:_________________________________

State the Authorized Purpose of Searches: Employment Related

______________________________________________ ____________
Signature of Authorized Company Representative Date

Permissible Purpose Code (Fair Credit Reporting Act: Pre Employment

Account Representative:_________________________________________

EMPLOYMENT SCREENING AGREEMENT FOR SERVICE

The undersigned ("End User") has entered into an agreement with Dealers Insurance Services inc, its associates and affiliates ("Provider") pursuant to which End User may order certain consumer information through Provider. End User would like the ability to obtain consumer information ("Repository Information") from Trans Union LLC, Equifax Credit Information Services, Inc., and/or Experian Information Solutions, Inc. (or their contractual affiliates) if and when available through Provider separately or as part of or in combination with other consumer information. Provider obtains Repository Information and other consumer information through multiple sources, and passes through such information to end-users. As a condition of permitting Provider to provide End User with Repository Information and other consumer information (together, "Credit Reports"), Provider requires End User to enter into this agreement and, End User agrees to do so in order to obtain such information through Provider. End User agrees to the following:

  • End User agrees not to resell or otherwise distribute any Credit Reports to any third party except as required by law.
  • End User represents that until it notifies Provider otherwise in writing, End User is not a private detective, detective agency, investigative company, bail bondsman, attorney or law firm, credit or financial counseling firm, "credit repair clinic" (each, a "Restricted Company"), and that End User will be the sole end user of all Credit Reports. If End-User is a Restricted Company, it may order Credit Reports only if an authorized officer certifies in writing that the Credit Report will be used solely in connection with the Restricted Company's own "employment purposes", i.e., for the purpose of evaluating the subject ("Consumer") for employment, promotion, reassignment, or retention as an employee.
  • End User understands its obligations under the federal Fair Credit Reporting Act ("FCRA"), the Americans With Disabilities Act ("ADA"), and applicable state laws in ordering and using Credit Reports for employment and other purposes, will comply with all such obligations, and will be responsible for its own regulatory compliance. End User has received a copy of the Federal Trade Commission's "Notice to Users of Consumer Reports: Obligations of Users Under the FCRA" and Chapter Nine of Technical Assistance Manual (I) for the ADA.
  • End User certifies that it will order Credit Reports solely for employment purposes and for no other purpose unless End User specifically notifies Provider that End User intends to use Credit Reports for another purpose. In such case, End User certifies that it will use the Credit Report solely for the other permissible purpose indicated in its order and for no other purpose.
  • In connection with ordering Credit Reports for employment purposes, End User agrees:
    1. End-User certifies that each time it orders Credit Reports for employment purposes:
      • End User is ordering Credit Reports solely for employment purposes, and will not use the Credit Reports for any other purpose.
      • Prior to ordering Credit Reports, (i) End User has given a clear and conspicuous disclosure to the Consumer, in a document that consists solely of the disclosure, that End User is obtaining a consumer report on the Consumer for employment purposes, and, (ii) the Consumer has authorized End User in writing to obtain the report for such purposes.
      • Prior to taking any adverse action based in whole or in part on such Credit Report, End User will provide the Consumer with a copy of the Credit Report, and a description in writing of the rights of the Consumer under the FCRA in the form published by the Federal Trade Commission, a copy of which has been provided to End User.
      • End User will not use any Credit Report in violation of any federal or state equal opportunity law or regulation; order any workers' compensation information on a Consumer unless End User has made a conditional offer of employment to the Consumer; or use such information in violation of the FCRA, ADA, or any applicable state law.
    2. When End User is ordering Credit Reports for tenant screening purposes, all permissible purpose requirements and FCRA regulations will apply as described in Section E.1(a-d) In addition, together with each order of Credit Report for employment purposes and or tenant screening, End-User will recertify as to the matters set forth above and provide such recertification to Provider.
    3. End User will retain the consumer authorizations described in Section E.1(b) above for at least two (2) years, and will make available copies or originals of any or all such authorizations as may be requested from time to time by Provider. Prior to destroying any such authorization, End User will notify Provider and give Provider a reasonable opportunity to obtain the authorization at their expense.
    4. If Repository Information that is used for employment purposes contains matters of public record that are likely to have adverse effect upon the consumer's ability to obtain employment, Provider reserves the right to notify the consumer that public record information is being reported to End User and to provide End User's name and address to the consumer.
  • End User will verify the identities of the subjects of all Credit Reports, obtain the permission of each Consumer to obtain the Credit Reports when required under applicable federal and state laws in the form required under such laws, provide all notices and disclosures required under such laws, refer Consumers to Provider for all inquiries regarding Credit Reports, and permit Provider to audit End User's procedures related to this agreement.
  • ALL CREDIT REPORTS ARE PROVIDED "AS IS." PROVIDER DOES NOT MAKE ANY REPRESENTATION OR WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR PARTICULAR PURPOSE, AND IMPLIED WARRANTIES ARISING FROM THE COURSE OF DEALING OR A COURSE OF PERFORMANCE WITH RESPECT TO THE ACCURACY, VALIDITY, OR COMPLETENESS OF ANY CREDIT REPORT, THAT WILL MEET END USER'S NEEDS, OR THAT WILL BE PROVIDED ON AN UNINTERRUPTED BASIS, AND PROVIDER EXPRESSLY DISCLAIM ALL SUCH REPRESENTATIONS AND WARRANTIES.
  • Provider will not be liable for any indirect, consequential, or special damages or damages for loss of profits, whether incurred as a result of negligence or otherwise, even if they have been advised of the possibility of such damages. Provider's maximum aggregate liability for damages in connection with Credit Reports will not exceed an amount equal to the price paid by End User to Provider for such information.
  • End User indemnifies, defends, and holds harmless Provider from and against any and all claims, suits, proceedings, damages, costs, expenses (including, without limitation, reasonable attorney fees and court costs) brought against, or suffered by, any such person arising or resulting from, or otherwise in connection with, any breach by End User of any of its representations, warranties, or agreements in this agreement.
  • End User will pay Provider directly for Provider's charges in connection with Credit Reports ordered by End User. This agreement constitutes the entire agreement of the parities with respect to its subject matter, and supersedes any contemporaneous or prior written or oral proposals, representations, or other communications regarding such subject matter, whether by Provider, or any other person, except that the terms of End-User's existing agreement with Provider will continue in full force and effect; provided, however, that in the event of an irreconcilable inconsistency between a provision of such agreement and this agreement, the provisions of this agreement shall control. Provider may assign this agreement and all of its rights and obligations hereunder to any of its affiliates without notice to End User. No change may be made to this agreement except in writing executed by End User, Provider, and the Compliance Officer or other authorized officer of Provider. This agreement shall be interpreted in accordance with the laws of the state of Florida, without reference to principles of conflict of laws of such state.

Any party may terminate this agreement without cause or penalty, effective upon prior written notice to the other parties. Upon any such termination, End User will no longer have access to Credit Reports that contain any Provider information. Termination of this agreement will not effect any obligations arising prior to the effective date of termination with limitations of liabilities set forth above.

Business Owner agrees to pay invoices from provider on a monthly basis by check (Due Upon Receipt), or on date of invoice through a Major Credit Card.

Any invoices not paid within agreed time frame will be placed on credit card only status.

To be completed by End User/ Dealer:

Agreed to by: ___________________________ Title ___________________
(please print)

Company Name ________________________________________

Address: ___________________________City ___________ State ____ Zip_________

Signature _______________________________ Date___________________

Not valid until accepted by PROVIDER: Name___________________________________
(please print)

Signature _____________________________________________________

Please note these Releases/Authorizations are subject to FCRA audit and you must maintain this signed release in your records for at least two years..

In most cases we will not require a copy of the release form for our files.

Some States will require release forms specific to their state.