HomeMy WebLinkAboutFCRA Form (Standard Form) 2023 CITY OF LANSING
DEPARTMENT OF HUMAN RESOURCES
8th Floor, City Hall . Benefits/Classifications (517) 483-4004 (Voice/TDD)
124 W. Michigan Avenue Labor Relations/Recruitment (517) 483-6064 (General Fax)
Lansing, Michigan 48933 Safety/Selection/Training www.lansingmi.gov (Website)
Worker’s Compensation
“Equal Opportunity Employer”
Elizabeth O’Leary, HR Director
Ellery Sosebee
Chief of Police
FCRA DISCLOSURE
This is to inform you that as a part of processing your application, a consumer report may be obtained for
employment purposes.
APPLICANT AUTHORIZATION
Without reservation, I authorize this employer or any party or agency contacted by this employer to procure my
consumer report and / or obtain of furnish information concerning my credit, criminal, motor vehicle, and other
history. I understand that inquiries may be made to various federal and state agencies, employers, references,
acquaintances, and others seeking information as to my personal characteristics, credit worthiness, employment
status, general reputation, and mode of living.
Signature:________________________________________ Date:_________________
*Date of Birth:____________________
*This information is requested by CBC Employment Screening Services solely for the purposes of ensuring accurate retrieval of
records.