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Background Check Notice & Authorization

  1. BACKGROUND CHECK NOTICE & AUTHORIZATION

    [IMPORTANT -- PLEASE READ CAREFULLY BEFORE SIGNING ACKNOWLEDGMENT]

  2. NOTICE REGARDING BACKGROUND CHECK

    The City of Las Cruces may obtain information about you from a consumer reporting agency for volunteer purposes. Thus, you may be the subject of a “consumer report” and/or an “investigative consumer report” which may include a criminal records check, sex offender records check, identity check, address history check, information about your character, general reputation, personal characteristics, and/or mode of living, and which may involve a driving record check, personal reference checks with sources such as your current and past employers, friends, or associates. These reports may be obtained at any time after receipt of your authorization and, if you are accepted, throughout your volunteer status with the above named organization. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report. Please be advised that the nature and scope of the most common form of “investigative consumer report” obtained with regard to volunteer applicants is an investigation into your personal and employment references conducted by Honesta Screening Systems, 811 Chelsea St., Suite B, El Paso, TX 79903. The scope of this notice and authorization is all-encompassing and allows The City of Las Cruces to obtain from any outside organization all manner of consumer reports and investigative consumer reports now and, if you are accepted, throughout the course of your volunteer status with this organization to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report.

  3. ACKNOWLEDGMENT AND AUTHORIZATION

    I acknowledge receipt of the NOTICE REGARDING BACKGROUND CHECK and certify that I have read and understand it. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” at any time after receipt of this authorization as long as I am a volunteer with The City of Las Cruces To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by Honesta Screening Systems another outside organization acting on behalf of The City of Las Cruces I agree that a facsimile (“fax”) or photographic copy of this Authorization shall be as valid as the original.

  4. The following is for identification purposes only to perform the background check and will not be used for any other purpose (***TO AVOID DELAYS PLEASE WRITE AS LEGIBLY AS POSSIBLE***):

  5. Previous Cities and States lived in during the past 7 years:

  6. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your Authorization will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

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  8. This field is not part of the form submission.