ADVISEMENT TO CHP APPLICANTS REGARDING THE USE OF … · New 04/12 - New Form adopted from old Chp...

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STATE OF CALIFORNIA - TRANSPORTATION AGENCY DEPARTMENT OF CALIFORNIA HIGHWAY PATROL ADVISEMENT TO CHP APPLICANTS REGARDING THE USE OF CREDIT REPORT INFORMATION FOR EMPLOYMENT PURPOSES The U.S. Fair Credit Reporting Reform Act (F.C.R.A) of 1996 (15 U.S. Code § 1681 Section 604(b)) and California's Consumer Credit Reporting Agencies Act (Civil Code §1785 et seq) require that you be notified separately of your rights before any prospective employer may use credit data as a part of their employment decision. In this case, an evaluation of your financial history is mandated by law contained in California Labor Code Section 1024.5(a)(3) because the position sought is that of a sworn peace officer or other law enforcement position. You are hereby notified that the California Highway Patrol intends to use credit data as part of its decision making process for the position for which you have applied. The Credit Reporting Agency which will furnish this data will be TransUnion, P.O. Box 1000, Chester, PA 19022-2000, (800) 916-8800. You will automatically be furnished a copy of this report, but before any adverse actions are taken as a result of this document, you are advised of the following: 1. You must be told if information in your file has been used against you; 2. Access to your file is limited to persons recognized by F.C.R.A; 3. Your consent is required for reports that are provided to employers or that contain medical information; 4. You can find out what is in your file, although some information, such as “risk scores” or “credit scores” may be lawfully withheld; 5. You can dispute inaccurate information with the Credit Reporting Agency; 6. Inaccurate information must be corrected or deleted; 7. Outdated information may not be reported (seven years for most information, ten years for bankruptcies); 8. You may choose to exclude your name for F.C.R.A. lists for unsolicited credit and insurance offers; 9. You may seek damages from violators; 10. You have the right to ask for a credit score; 11. Identity theft victims and active duty military personnel have additional rights; 12. The complete text of this Act may be found on the Internet at http://www.ftc.gov; CERTIFICATION: I certify that the California Highway Patrol has my consent to obtain a copy of my credit report for the limited purpose of my pre-employment background investigation. I certify that I have been furnished with the name, address and telephone number of the Credit Reporting Agency, I have been informed that I will receive a copy of my credit report and that I have been informed in summary form of my rights under the F.C.R.A. TO BE COMPLETED BY APPLICANT (In accordance with the Federal Privacy Act of 1974, disclosure is voluntary. The S.S.N. will be used for identification purposes to ensure that proper records are obtained.) CHP 432C (New 5-12) OPI 094 Chp432C_0419.pdf PRINTED NAME SIGNATURE DATE OTHER NAMES USED (MAIDEN NAME, NICKNAMES, ETC) ADDRESS SOCIAL SECURITY NUMBER

Transcript of ADVISEMENT TO CHP APPLICANTS REGARDING THE USE OF … · New 04/12 - New Form adopted from old Chp...

Page 1: ADVISEMENT TO CHP APPLICANTS REGARDING THE USE OF … · New 04/12 - New Form adopted from old Chp 432B with different veribage and purpose. There are no fillable fields in this form

STATE OF CALIFORNIA - TRANSPORTATION AGENCY

DEPARTMENT OF CALIFORNIA HIGHWAY PATROL

ADVISEMENT TO CHP APPLICANTS REGARDING THE USE OF CREDIT REPORT INFORMATION FOR EMPLOYMENT PURPOSES

The U.S. Fair Credit Reporting Reform Act (F.C.R.A) of 1996 (15 U.S. Code § 1681 Section 604(b)) and California's Consumer Credit Reporting Agencies Act (Civil Code §1785 et seq) require that you be notified separately of your rights before any prospective employer may use credit data as a part of their employment decision. In this case, an evaluation of your financial history is mandated by law contained in California Labor Code Section 1024.5(a)(3) because the position sought is that of a sworn peace officer or other law enforcement position. You are hereby notified that the California Highway Patrol intends to use credit data as part of its decision making process for the position for which you have applied. The Credit Reporting Agency which will furnish this data will be TransUnion, P.O. Box 1000, Chester, PA 19022-2000, (800) 916-8800. You will automatically be furnished a copy of this report, but before any adverse actions are taken as a result of this document, you are advised of the following:

1. You must be told if information in your file has been used against you; 2. Access to your file is limited to persons recognized by F.C.R.A; 3. Your consent is required for reports that are provided to employers or that contain medical information; 4. You can find out what is in your file, although some information, such as “risk scores” or “credit scores” may be lawfully

withheld; 5. You can dispute inaccurate information with the Credit Reporting Agency; 6. Inaccurate information must be corrected or deleted; 7. Outdated information may not be reported (seven years for most information, ten years for bankruptcies); 8. You may choose to exclude your name for F.C.R.A. lists for unsolicited credit and insurance offers; 9. You may seek damages from violators; 10. You have the right to ask for a credit score; 11. Identity theft victims and active duty military personnel have additional rights; 12. The complete text of this Act may be found on the Internet at http://www.ftc.gov;

CERTIFICATION: I certify that the California Highway Patrol has my consent to obtain a copy of my credit report for the limited purpose of my pre-employment background investigation. I certify that I have been furnished with the name, address and telephone number of the Credit Reporting Agency, I have been informed that I will receive a copy of my credit report and that I have been informed in summary form of my rights under the F.C.R.A.

TO BE COMPLETED BY APPLICANT

(In accordance with the Federal Privacy Act of 1974, disclosure is voluntary. The S.S.N. will be used for identification purposes to ensure that proper records are obtained.)

CHP 432C (New 5-12) OPI 094 Chp432C_0419.pdf

PRINTED NAME SIGNATURE DATE

OTHER NAMES USED (MAIDEN NAME, NICKNAMES, ETC) ADDRESS

SOCIAL SECURITY NUMBER