DISCLOSURE AND AUTHORIZATION: Background Check
[IMPORTANT -- PLEASE READ CAREFULLY BEFORE SIGNING AUTHORIZATION & DISCLOSURE REGARDING BACKGROUND INVESTIGATION
Los Angeles Skills Academy may obtain information about you for educational/future healthcare employment placement purposes from a third party consumer reporting agency. Thus, you may be the subject of a "consumer report" and/or an "investigative consumer report" which may include information about your character, general reputation, personal characteristics, and/or mode of living. These reports may contain information regarding your criminal history, social security verification or other background checks. You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you, and disclosure of the nature and scope of any investigative consumer report and to request a copy of your report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for educational/future healthcare employment placement is an investigation conducted by Asurint, Compliance Department, P.O. Box 14730, Cleveland, OH 44145, (800) 906-2034, www.asurint.com/Compliance.aspx,or another outside organization. The scope of this notice and authorization is all-encompassing, however, allowing the company to obtain from any outside organization all manner of consumer reports and investigative consumer reports now and throughout the course of your educational/future healthcare employment placement to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report.
New York and Maine applicants: You have the right to inspect and receive a copy of any investigative consumer report requested by LASA by contacting the consumer reporting agency identified above directly. You may also contact LASA to request the name, address, and telephone number of the nearest unit of the consumer reporting agency designated to handle inquiries, which LASA shall provide within 5 days.
New York applicants: Upon request, you will be informed whether or not a consumer report was requested by LASA, and if such a report was requested, informed of the name and address of the consumer reporting agency that furnished the report. By signing below, you also acknowledge receipt of Article 23-A of the New York Correction Law.
Oregon applicants or employees only: Information describing your rights under federal and Oregon law regarding consumer identity theft protection, the storage and disposal of your credit information, and remedies available should you suspect or find that LASA has not maintained secured records are available to you upon request.
Washington State applicants or employees only: You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act.
ACKNOWLEDGMENT AND AUTHORIZATION
I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understood both of those documents. I hereby authorize the obtaining of "consumer reports" and/or "investigative consumer reports" by LASA at any time after receiving this authorization and throughout my educational/future healthcare employment placement if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employe,r or insurance company to furnish any and all background information requested by Asurint, Compliance Department, P.O. Box 14730, Cleveland, OH 44145,(800) 906-2034, www.asurint.com/Compliance.aspx, another outside organization acting on behalf of ARC, and/or ARC itself. I agree that a facsimile ("fax"), electronic or photographic copy of this Authorization shall be as valid as the original.
New York applicants: By signing below, you also acknowledge receipt of Article 23-A of the New York Correction Law.
Minnesota and Oklahoma applicants: Please check this box if you would like to receive a copy of a consumer report if one is obtained by ARC. □
California applicants or employees only: By signing below, you also acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check this box if you would like to receive a copy of an investigative consumer report or consumer credit report at no charge if one is obtained by LASA whenever you have a right to receive such a copy under California law.
*This information will be used for background screening purposes only and will not be used as hiring criteria.
If registering online, the student is authorizing this background check by way of paying for the class. A checkbox replaces the need for signature when registering online.