In connection with my application for employment with Texas Woman’s University, I understand that prior to or at any time after my employment commences a Consumer Report may be requested for employment purposes from Texas Woman’s University (TWU) from public records including, but not limited to Social Security number, motor vehicle operation history and criminal history to the extent permitted by law from various local state, and federal agencies. Further, I understand that an Investigative Consumer Report may be requested and, as required under § 1681d(a)(1), I understand that this Report may include information as to my character, general reputation personal characteristics, mode of living, work habits, performance experience, along with reasons for termination of past employment, whichever are applicable, obtained through personal interviews with associates who have knowledge concerning such items of information.
I VOLUNTARILY AND KNOWINGLY AUTHORIZE ANY PRESENT OR PAST EMPLOYER OR SUPERVISOR; COLLEGE OR UNIVERSITY OR OTHER INSTITUTION OF LEARNING; ADMINISTRATOR; LAW ENFORCEMENT AGENCY, STATE AGENCY, LOCAL AGENCY, FEDERAL AGENCY; CREDIT BUREAU; COLLECTION AGENCY; PRIVATE BUSINESS; MILITARY BRANCH OR THE NATIONAL PERSONNEL RECORDS CENTER PERSONAL REFERENCE; AND/OR OTHER PERSONS TO GIVE RECORDS OR INFORMATION THEY MAY HAVE CONCERNING MY CRIMINAL HISTORY, MOTOR VEHICLE HISTORY, SOCIAL SECURITY NUMBER, EARNINGS HISTORY, CHARACTER, AND EMPLOYMENT (INCLUDING REASONS FOR TERMINATION)OR ANY OTHER INFORMATION REQUESTED BY TWU.
I understand that I have the right to request a complete and accurate disclosure of the nature and scope of the investigation requested. Further, I am entitled to know if employment is denied because of information obtained by my prospective employer from a Reporting Agency. If so, I will be so advised in writing and be given the name and address of the agency, a statement that the action was based in whole or in part on information contained in the Report, and written notice that I have the right (i) if I request, to obtain within sixty days a free copy of the Report from the Reporting Agency, and from any other consumer credit Reporting Agency which compiles and maintains files on consumers on a nationwide basis; and (ii) to dispute the accuracy or completeness of any information in a consumer credit report furnished by the Reporting Agency. I understand that upon my request with reasonable notice, TWU will supply me with investigative information in my file during normal business hours in person or upon written request, by mail or telephone as permitted by law.
I understand that any Consumer Report or Investigative Consumer Report requested will be used strictly for employment purposes as defined under the Fair Credit Reporting Act §603(h), as a report to be used for the purpose of evaluation for employment promotion, reassignment or retention as an employee. I further understand that any offer of employment, promotion or reassignment will be conditional upon the receipt of satisfactory information as required by and that to be considered for employment promotion, or reassignment, I must authorize the procurement of such Report(s). A photographic or faxed copy of this Notification and Release Authorization shall be as valid as the original.
State law (Leg. House Bill 1922) with limited exception, allow you to be informed about information the University collects about you, to review and obtain the information on this form and to correct any information you believe is incorrect.
Disclosure of you social security number (SSN) is required under this form for identification purposes. Any further disclosure of your SSN will be governed by The Public Info. Act (Chapter 552 of the Texas Govt. Code)
I certify that the statements made by me in this application are true, complete, and correct to the best of my knowledge and belief and are made in good faith. I understand that any false statements made herein may void this application and any actions based on it. I understand that any offer of employment tendered me is contingent upon my agreement to abide by the rules and regulations of the Board of Regents of The Texas Woman’s University. I understand that employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either the University or the employee. I authorized Texas Woman’s University to contact references and former employers. In the event that I am in a position deemed by the Institution to warrant a background investigation, I authorize the Institution to conduct a police inquiry regarding any past or current charges, convictions investigations, etc. I understand that all offers of employment extended by the Texas Woman’s University will be contingent upon my ability to provide documents which establish proof of my identity and eligibility in the United States.
Last Name______________________________________ First Name_________________________ Middle Name/Initial_________
Social Security Number__________________________ Driver’s License Number_______________________ State issued________
D.O.B._____________________ Have you used any names or social security numbers other than above? Yes_______ No________
Please list other names used________________________________ Please list other SS number used__________________________
Signature__________________________________________________ Today’s Date_________________________