Employment Screening Services Inc
www.empscreening.com
Notarized Affidavit of Use of Information Supplied by Employment Screening Services Inc (ESS)
In compliance with the Fair Credit Reporting Act (FCRA), Drivers Privacy Protection Act (DPPA) and Gramm-Leach-Bliley Act (GLBA), I, as an authorized representative of
____________________________ do attest that the company and its representatives:
(company)
have read, understand and agree to abide by the terms set forth in the FCRA, DPPA and GLBA
will only use the requested information for purposes of employment and/or tenant screening
will only request such information with the written consent of the subject of the screening
will keep the subject’s signed waiver authorizing the tenant and/or employment screening on file for a minimum of three years
will not refuse to hire or lease to the subject of a screening in violation of any applicable local, state, federal or international law or regulation
acknowledge the report is for a one-time use and will hold such report in strict confidence and not disclose it to any third parties not involved in the employment and/or tenant screening process.
_______________________________________ ______________________________________
Typed or Printed Company Name Typed or Printed Name of Authorized Signer
_______________________________________ _______________________________________
Company Address Authorized Signature
_______________________________________ _______________________________________
Tax ID Number Date
_______________________________________________________________________________________
Be it recorded that on this_____ day of _________________ 20___, before me, the undersigned Notary Public in and said county and state, personally appeared _____________________________________, known to me to be, or having supplied sufficient proof of being, the same individual described herein and who executed this affidavit freely and voluntarily.
_____________________________ (NOTARY PUBLIC)
If using embossed seal, please complete the following:
Notary Name: ___________________________
Commission #: __________________________
Commission Expires: _____________________
Jurisdiction: ____________________________ |
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- Private Investigative Agency License No. A2300376 –
P.O. Box 3882 - Lantana, FL 33465 - 561-533-0488 - info@empscreening.com
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