Universal Employment Background Check & Combined Disclosure Notice/Authorization Regarding Investigative Consumer Reports

Date
First Name
Middle Name
Last Name
City
State
Zip Code
I understand that as a condition of my consideration for employment, or as a condition of my continued employment, Nielsen’s House of Learning (the company) may obtain a consumer report and/or investigative consumer report that includes, but is not limited to: employment and education verifications; social security number verification; criminal and civil court records; personal interviews; driving records; and/or any other public records or any other information bearing on my character, general reputation, personal characteristics and trustworthiness.
I hereby authorize and consent the company and/or its designated agent to procure such a report. I understand that pursuant to the Federal Fair Credit Reporting Act, Nielsen’s House of Learning will provide me with a copy of any such report if the information contained in such report is, in any way, to be used in making an adverse decision regarding my fitness for employment. I further understand that such report will be made available to me prior to any such adverse decision being made, along with the name and address of the reporting agency that produced the report.
Type "YES" if you agree to the above:
Driver's License Number:
Please provide all residential addresses for the past 5 (five) years.
Do you need to send additonal information under a seperate cover?

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