DAC


DAC Form

As part of the employment process, G-Line Trucking, Inc. (the “Company”), may obtain a Consumer Report and/or an Investigative Consumer Report. The Fair Credit Reporting Act as amended by the Consumer Reporting Reform Act of 1996 and the Fair and Accurate Credit Transactions Act of 2003 requires that we advise you that for purposes of employment only, a Consumer Report may be made which may include information about your credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living.

Upon written request, additional information as to the nature and scope of the report, if one is made, will be provided, in the event the Report contains information regarding your character, general reputation, personal characteristics, or mode of living. Upon written request to the Company, I have the right to be informed as to the nature and scope of an Investigative Consumer Report, the name and address of the consumer reporting agency providing the report, and a written summary of my rights. According to the Fair Credit Reporting Act, I am entitled, before any adverse action s taken based on information obtained by the Company, to receive a copy of the consumer report and a description of my rights as a consumer.

AUTHORIZATION & RELEASE

I authorize the Company to procure a Consumer Report on me that is prepared by a consumer reporting agency. I understand the Consumer Report may include information regarding my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. I further understand that, if I am hired, the Company may rely on this authorization to procure additional Consumer Reports during and throughout my employment without asking for my authorization again.

I also authorize the following entities to disclose to the consumer reporting agency and its agents all information about or concerning me, including, but not limited to: my past or present employers; learning institutions, including colleges and universities; law enforcement and all other federal, state and local agencies; federal, state and local courts; the military; credit bureaus; testing facilities; motor vehicle records agencies; all other private and public sector repositories of information; and, any other person, organization or agency with any information about or concerning me. The information that can be disclosed to the consumer reporting agency and its agents includes, but is not limited to, information concerning my employment history, earnings history, education, credit history, motor vehicle history, criminal history, drug test results, military service, professional credentials, and all other information requested by the consumer reporting agency or its agents. I am willing that a photocopy and/or electronic copy of this authorization be accepted with the same authority as the original.


Social Security # 
Date of Birth 
Drivers License #
Drivers’s License Issuing State   
Contact phone # 
If name changed (e.g., through marriage) print former name here  
For California applicants only, if you would like to receive a copy of the credit report or investigative consumer
report, if one is obtained, please check this box 

 
For Minnesota or Oklahoma applicants only, if you would like to receive a copy of the consumer report, if one is obtained, please check this box      

 

 

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Gline Trucking Inc. http://glinetrucking.com
Signature Certificate
Document name: DAC
Unique Document ID: 791c7cf98e25a09542a7fc0240a69a74d81231fb
Timestamp Audit
2016-03-09 09:43:36 CSTDAC Uploaded by Paul oberbroeckling - poberbroeckling@glinetrucking.com IP 69.66.204.77