[ + ]   Federal Disclosure

FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT

A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT

Checkmark you have read and understand both the FCRA Disclosure Statement and FCRA Summary of Rights (REQUIRED):

[ + ]   State, Local and Other Disclosures
Some states and localities provide additional rights, in addition to the federal rights described above. As a courtesy to you, Cluso Investigation provides certain information about these laws. If you live in any of the following states or cities -- or if you would move to any of the following states or cities if you are hired – click below for further information. (Note: While Cluso Investigation endeavors to provide complete and up-to-date information, it makes no guarantee that this information about state and local laws is complete or current.)












I acknowledge that I have read and understand the above applicable state/local disclosures or, if none provided, that the above locations are not applicable to me (REQUIRED):

[ + ]   Instructions
  • Please read the Fair Credit Reporting Rights information and the other disclosures provided, and make sure you understand them (questions? Call your recruiter).
  • Then, please complete the Background Check Authorization Form by providing all information requested.
  • Expand and collapse the sections below by clicking on the section header.
  • You should gather all information needed for this form first and take less than 8 hours from logging in to fill and Submit this release. You'll need ID info, Exact Employment Info, Exact Education Info, References and Gaps Listed.
  • Any documents, proof, or other information you are submitting can be attached to this form in the appropriate section. Please ONLY Attach PDF files or small sized (under 1 MB) non-PDF files.
    NOTE: There is a 10 MB maximum limit for all documents combined using this form. Exceeding this limit will result in unsuccessful submission. Any additional documents / information not attached to this form can be uploaded to https://secure.cluso.com/DocUpload
    The 10 MB limit exists on that page also but can be submitted multiple times if necessary.
  • Please fill in this form, read the Fair Credit Reporting Rights information and Press the SUBMIT button.
[ + ]   Personal Information
Legal First Name:
Legal Middle Name:
Legal Last Name:
Suffix (ex: Jr., Sr., if applicable):
Gender:
Your Email Address:
Your Telephone Number:
If applicable, Please list your Maiden name:
Have you have used another name (Y/N):
If you marked Yes to "Alias", Please list the names in the following fields:
SSN (US only):
Canada SIN:
Date of Birth (format MM/DD/YYYY):
Drivers License Country:

Drivers License State/Province:

Drivers License #:

[ + ]   Fill this Section if you Lived or Worked outside of the USA in the past 7 years
Nationality (if Non-USA):

Passport Issuing Country (if Non-USA):

Passport Number (if Non-USA):
PAN or Other National Citizen ID (non-USA):
If you hold a non-USA issued Passport, list your father's name:
If you hold a South American Passport, list your Mother's maiden name:

Passport/ID Scan:


[ + ]   Residential Address History

List Your Current Address:


Country:

Street: Apt Num/Suite/Other:
City: State/Province:

Zip/Postal Code:
Date Range (format MM/YYYY): to Present

List All Previous Addresses Lived Within the Past 7 Years:


2. Country:

Street: Apt Num/Suite/Other:
City: State/Province:

Zip/Postal Code:
Date Range (format MM/YYYY): to

3. Country:

Street: Apt Num/Suite/Other:
City: State/Province:

Zip/Postal Code:
Date Range (format MM/YYYY): to

[ + ]   ADD RESIDENTIAL ADDRESS
4. Country:

Street: Apt Num/Suite/Other:
City: State/Province:

Zip/Postal Code:
Date Range (format MM/YYYY): to
[ + ]   ADD RESIDENTIAL ADDRESS
5. Country:

Street: Apt Num/Suite/Other:
City: State/Province:

Zip/Postal Code:
Date Range (format MM/YYYY): to
[ + ]   ADD RESIDENTIAL ADDRESS
6. Country:

Street: Apt Num/Suite/Other:
City: State/Province:

Zip/Postal Code:
Date Range (format MM/YYYY): to
[ + ]   ADD RESIDENTIAL ADDRESS
7. Country:

Street: Apt Num/Suite/Other:
City: State/Province:

Zip/Postal Code:
Date Range (format MM/YYYY): to
[ + ]   ADD RESIDENTIAL ADDRESS
8. Country:

Street: Apt Num/Suite/Other:
City: State/Province:

Zip/Postal Code:
Date Range (format MM/YYYY): to
[ + ]   Authorization, Release, and Arbitration Agreement

In consideration of being considered by MARTIN UNITED METHODIST CHURCH or its customer for a position, I hereby authorize MARTIN UNITED METHODIST CHURCH and its agents, including but not limited to Cluso Investigation LLC, to perform the required investigative inquiries into my personal background, covering the counties and states where I have been employed or resided for the past seven years or longer as permitted by law. MARTIN UNITED METHODIST CHURCH and its agents, including but not limited to Cluso Investigation LLC, have my authorization to develop information regarding my work habits, skills, and general character from employers, personal references, schools, or institutions, including but not limited to state workers’ compensation histories, and/or obtain information from law enforcement, judicial, and military authorities concerning my conduct or criminal history (including but not limited to traffic violations), and to share such information with MARTIN UNITED METHODIST CHURCH’s customer if applicable.

I authorize any current or former employer, school, or other organization or entity identified herein to release any information about me to Cluso Investigation LLC or MARTIN UNITED METHODIST CHURCH, including but not limited to personnel records, educational records, and any records concerning drug or alcohol testing or any refusal to consent to testing. A facsimile, photocopy or other copy of this authorization may be accepted by anyone as though it were an original.

I consent to the release of my Motor Vehicle Records (MVR) to MARTIN UNITED METHODIST CHURCH and its agents under the provisions of the Federal Driver’s Privacy and Protection Act and in accordance with any other applicable local, state or federal laws.

I understand that this Background Check Release Form is not to be deemed a request to obtain or release any information where such request or release is not permitted by applicable law. I further understand that the results of any pre-employment investigation, if found to be unsatisfactory according to the policy(ies) of MARTIN UNITED METHODIST CHURCH or a prospective employer if different, may be cause for denial of employment.

I hereby certify that all information furnished by me herein is true, complete, and accurate to the best of my knowledge.

I hereby release MARTIN UNITED METHODIST CHURCH, Cluso Investigation LLC, their respective affiliates and customers, and all officers, directors, agents, employees, and representatives of any of the foregoing, of and from any claims or liabilities of any kind resulting from such background investigations or the provision or use of information derived through such investigations, including but not limited to the denial of employment.


ANY DISPUTE BETWEEN YOU (THE CANDIDATE FOR EMPLOYMENT) AND CLUSO INVESTIGATION OR ANY OF ITS OFFICERS, EMPLOYEES, AGENTS, OR REPRESENTATIVES WHICH CANNOT BE RESOLVED AMICABLY WILL BE RESOLVED BY BINDING ARBITRATION IN DALLAS COUNTY OR TARRANT COUNTY, TEXAS AND NO OTHER LOCATION, UNDER TEXAS AND U.S. LAW, UNDER THE COMMERCIAL ARBITRATION RULES OF THE AMERICAN ARBITRATION ASSOCIATION, AND JUDGMENT MAY BE ENTERED UPON THE AWARD IN ANY COURT OF COMPETENT JURISDICTION. YOU AND CLUSO INVESTIGATION AGREE AND WARRANT THAT EACH OF US MAY BRING CLAIMS AGAINST THE OTHER ONLY ON AN INDIVIDUAL BASIS AND NOT ON A CLASS, REPRESENTATIVE, OR COLLECTIVE BASIS, AND YOU AND CLUSO INVESTIGATION HEREBY WAIVE ALL RIGHTS TO HAVE ANY DISPUTE BE BROUGHT, HEARD, ADMINISTERED, RESOLVED, OR ARBITRATED ON A CLASS, REPRESENTATIVE, COLLECTIVE BASIS OR TO HAVE ANY DISPUTE HEARD BY JURY TRIAL. ONLY INDIVIDUAL RELIEF IS AVAILABLE, AND DISPUTES OF MORE THAN ONE PERSON CANNOT BE ARBITRATED OR CONSOLIDATED WITH THOSE OF ANY OTHER. THE ARBITRATOR MAY AWARD RELIEF ONLY IN FAVOR OF THE INDIVIDUAL PARTY SEEKING RELIEF AND ONLY TO THE EXTENT WARRANTED BY THE PARTY’S INDIVIDUAL CLAIM. If a court decides by means of a final decision, not subject to any further appeal or recourse, that the limitations of this section are invalid or unenforceable as to a particular claim or relief, you and Cluso Investigation agree that that particular claim or relief shall be severed from the arbitration and shall be litigated in the state or federal courts in and for Dallas County or Tarrant County, Texas and no other location. This subsection does not prevent you or Cluso Investigation from participating in a class-wide settlement of claims.

Your Text Signature:

Draw your signature by holding the left mouse button and dragging or by using your touchscreen.
Clear

and Print Name:

Date (format MM/DD/YYYY):

Print

NOTE: If you get an error message after submission, please hit the back button, correct and submit again.
The most likely cause of errors are file attachments. Try reducing the size of each attachment to under 1MB.
There is a 10 MB maximum limit for all documents combined using this form. Exceeding this limit will result in unsuccessful submission. Any additional documents / information not attached to this form can be uploaded to https://secure.cluso.com/DocUpload
The 10 MB limit exists on that page also but can be submitted multiple times if necessary.
If you are unable to submit the form for any other reason you can always print and email this authorization form with your attachments to ops@cluso.com with subject "Online Authorization Form with Attachments." Email size is limited to 4 MB so anything above will need to be submitted using the DocUpload link.
Be sure to include your name and the company you are filling the authorization form for.
If you are still experiencing issues, please make note of the error message and contact us at ops@cluso.com with subject "Online Authorization Form Error."