Credit_Check_Form_Fillable.pdf
PDF 63 KB Posted
- Attached to
- VARIOUS CORRUGATED BOXES, CONTAINERS, AND PACKING MATERIALS Federal contract opportunity
- Solicitation number
- CT2195-15
About this file
CREDIT INFORMATION RELEASE
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Text version
United States Department of Justice
Disclosure and Authorization Pertaining to Consumer Reports
Pursuant to the Fair Credit Reporting Act (Title 15, U.S. Code, Section 1681)
This is a release for the Department of Justice to obtain one or more consumer/credit reports about you in connection with your application for Federal employment, during the course of your
Federal employment (including employment under contract), and/or connection with your security clearance or your access to classified information. One or more reports about you may be obtained for purposes of evaluating your fitness for employment, promotion, reassignment, retention, access to classified information, or other employment proposes.
I,_____________________________________________________, hereby authorize the Department of (Print Clearly) Justice to obtain, and I further instruct any consumer/credit reporting agency to release to DOJ, any such report(s) for the above purposes.
Signature
Date
Social Security Number
Current Organization Assigned
DOJ-555
Revised Dec. 2004 Security and Emergency Planning Staff
| Print Clearly: |
| Date: |
| Social Security Number: |
| Current Organization Assigned: |
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