QUEEN’S CHAPEL UNITED METHODIST CHURCH

“Let all things be done decently and in order.” I Corinthians 14:40

7410 Old Muirkirk Road • Beltsville, Maryland 20705 • Administrative Office: (301) 210-9038 • Fax: (301) 210-9039
[email protected][email protected]

Disclosure

Notice to All Users of This Form:

As an employer and user of consumer reports, it is your responsibility to ensure compliance with all relevant federal, state, and local laws governing this area. This form is provided solely as a courtesy and should not be construed as legal advice. It is important that before using this or any form, you consult with your legal counsel.

DISCLOSURE AND AUTHORIZATION FOR EMPLOYER TO ACCESS CONSUMER REPORTS

Queen’s Chapel United Methodist Church | 7410 Old Muirkirk Road | Beltsville, MD 20705 | 301-210-9038

DISCLOSURE

By completing the form below, you acknowledge and understand that in connection with your volunteer application with QCUMC, or when deciding whether to modify your ongoing* volunteer position (if selected), we may obtain a “consumer report” and/or an “investigative consumer report” on you from TRAK-1, a consumer reporting agency, or from any third party, in strict compliance with both state and federal law. A consumer report is any communication of information by a consumer reporting agency bearing on your creditworthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used for purposes of serving as a factor in establishing your current and/or continuing eligibility for volunteer purposes.

An investigative consumer report is obtained through personal interviews with individuals who may know your character, general reputation, personal characteristics, or living mode. The consumer reports or investigative consumer reports may contain public record information which may be requested or made on you including, but not limited to: consumer credit, criminal records, civil cases in which you have been involved, driving history records, current motor vehicle insurance coverage, education records, previous employment history, workers compensation claims history, social security traces, military records, professional licensure records, eviction records, drug testing, government records, and others.

You further understand that these reports may include experience information along with reasons for termination of past volunteerism. You also acknowledge and understand that information from various federal, state, local, and other agencies that contain information about your past activities will be requested. You are hereby notified that you have the right to make a timely request for a copy of the scope and nature of the above investigative background report and/or a complete copy of your consumer report contained in QCUMC files on you at the time of your request by providing proper identification and the payment of any legally permissible fees. You are further notified that, before being denied a volunteer position based in whole or in part on information obtained in the consumer report, you will be provided a copy of the report, the name, address, and telephone number of the consumer reporting agency and a description in writing of your rights under the Fair Credit Reporting Act.

Correspondence to TRAK-1 should be forwarded to Trak-1 | Consumer Disputes | 7131 Riverside Parkway | Tulsa, Oklahoma 74136

California applicants: California Civil Code section 1786.16(2) requires a separate disclosure and authorization to be signed by an applicant or current employee each time a background check is performed for employment purposes. This requirement does not apply when the employer suspects wrongdoing or misconduct by a current employee.

Maine applicants: According to Maine state law, § 1317(2), Trak-1 is required to reinvestigate any consumer dispute made by a consumer residing in Maine within 21 calendar days of notification of the dispute by the consumer.

THE FAIR CREDIT REPORTING ACT GIVES YOU SPECIFIC RIGHTS IN DEALING WITH CONSUMER REPORTING AGENCIES. YOU WILL BE GIVEN A SUMMARY OF THESE RIGHTS TOGETHER WITH THIS DOCUMENT.

AUTHORIZATION

By signing below, you hereby authorize, without reservation, TRAK-1 or any third party contracted by this organization to furnish the above mentioned and requested information. You further authorize ongoing procurement of the above-mentioned information, reports, and records at any time during your volunteerism or in the course of considering you for a volunteer position. You also agree that a fax or photocopy of this authorization with your signature is accepted as having the same authority as the original. You further authorize and request, without reservation, any present or former employer, school, police department, financial institution, division of motor vehicles, consumer reporting agencies, or other persons or agencies knowing you to furnish QUEEN’S CHAPEL UMC with any background information in their possession regarding you, so that your volunteer qualifications may be evaluated and/or reassessed.

You may pay for the background screening by bringing a check or money order along with your completed form to the administrative office during normal office hours, or you may pay via the Queen’s Chapel website by clicking on the Online Giving link and choosing the option for background authorizations. The cost of background screening is $10.00. Only checks and money orders will be accepted at the administrative office. Please do not bring cash. Background reports will not be completed until payment is received. No one may work with children and youth at Queen’s Chapel United Methodist Church without having a background report completed through Trak-1.