DISCLOSURE AND AUTHORZATION

ItMpoRTANT
_ pLEASE
READ CAREFULLy EEFORE StcNtNG AUTHORTZATtONI
qLSElgst
JgE REGARllllc BAcKGROUIIQ
It\!\/ESTLGAItON
Gardner-webb
university (lhe company') may obtain information
about you from a consumer reporting
agency for enrollment or continued enrollment purposes.
Thus, you
may be the subject of a "consumer-
report" and/or an 'invesligative
consumer report'which may inciude information
about your
character,
general
reputation, personal
characteristics, and/or mode ol living. These reports may iontain information
regarding your credit history, criminal history, social secunty verification, motor vehicle records (.driving
records"), verification of your
education or employment history, or other background checks.
you
have"the
right, upon written request made within a reasonable time after receipt of thiJnotice, to request dtsclosure of
the nature and scope of any investigative consumer report. The scope of this notice and authorization is alt-
encompassing, however, allowing Gardner-webb university to obtain from any outside organization
all
manner of consumer reports and investigative consumer reporls now and throughout the iourse of your
enrollment to lhe extent permitted
by law. As a result, you
should carefully consider whether to exercise
y0ur right to request disclosure of the nature and scope of any investigative consumer reporr.
AQ{X9WLEDGMENT
AND AUTHORIZATION
I acknowledge receipt of he DtsclosuRE REGARDING BACKGRouND
tNVESTtGAT|oN
and cerrify
that I have read and understand this document. I hereby authorize the obtaining of
-conruret.
t..portr;
'
and/or.'invesligative
consumer reports' by the Company at any time after receipt of this authorization and
hroughout my employment, if applicable. To this end, I herebf authorize, without reservation,
any taw
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 Background
Data, rnc.,50 Jasmine court, Newnan, GA 3'0265, fill -nz-oilq,
another outside organization acting on behalf of Gardner-Webb University, and/or Gardner-Webb
University
itself l agree that a facsimile ('fax"),
electronic or photographic
copy of this Authorizatjon
shall be as valid as
the original.
Last Name
First
Middle
Other Names/Alias
Social Security'#
Dnver's License #
Present Address
Date of Birth'
State of Driver's License
Phone Number
City/State/Zip
Signature;
Date: