Background Investigation and Release of Information Authorization "*" indicates required fields DisclosureRequired Disclosure * RequiredPlease read carefully before submitting. The Fair Credit Reporting Act requires that we inform you that a background investigation may be conducted as a part of our employment screening and selection process. Kalamazoo College may obtain for employment purposes a consumer report (also referred to as a “credit report”) or an investigative consumer report concerning applicants or employees. This may include an inquiry to obtain information regarding your character, general reputation, personal characteristics and mode of living. Upon your written request within a reasonable period of time, additional information as to the nature and scope of the report, if one is made, will be provided, along with a written summary of your rights as a consumer. In addition, if a report is made, you have the right to request details of the report from the consumer reporting agency. We ask that you authorize Kalamazoo College to obtain such a report, and that you consent to the report being furnished to Kalamazoo College. To do so, please sign the authorization statement on this page below. The items of information requested below are needed to process your background investigation. They are intended solely for that purpose and will not be used in a discriminatory manner for the making of business decisions. I understand.Reason for Submission and Associated UnitIndicate the reason for submission * RequiredK Students: Select options 2 or 3 only. I have applied for employment or to be a volunteer I am requesting authorization to drive a College vehicle for College-related purposes Other Name of the unit in which you will be working, volunteering, or otherwise associated. * Required Transportation PolicyPolicy acknowledgement * RequiredYou are responsible for reading, understanding, and adhering to Kalamazoo College’s Transportation Policy, located at https://facilities.kzoo.edu/policies/#137. The Transportation Policy will also be sent to your email address. I understand and will comply with Kalamazoo College’s Transportation Policy.Legal InformationLegal Name * Required First Middle Last Suffix Address * Required Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email * Required Primary Phone * RequiredDate of birth * Required Month Day Year Gender * Required Female Male Other Social Security Number * Required Driver's License Number Driver's License State of IssuanceAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificDriver's License Expiration DateIndicate 01/01/1900 if there is no expiration date. Month Day Year Other name(s) used Criminal HistoryAre there any felony charges pending against you? * Required Yes No Please indicate the crime(s), country, state, county, and year. * Required Have you ever been convicted of a crime? * Required Yes No Please indicate the crime(s), country, state, county, and year. * Required Final Authorization and SignatureAuthorization and consent for release of information * RequiredAfter reading this document, I fully understand the contents and authorize Kalamazoo College to conduct a background verification. I authorize Kalamazoo College and its agents to request and receive an investigative consumer report concerning me and to investigate my background as it pertains to employment considerations. This may include investigation of employment history and performance, personal/professional references, educational history, licenses and information contained in public records including credit, criminal, driving record, motor vehicle data and worker’s compensation. I release all persons, companies, or corporations furnishing such information from liability and responsibility. I understand and agree that: The information supplied was submitted by myself, and all information is true and correct, to the best of my knowledge. I understand that false or misleading information given in my application and/or interview(s) will be considered as cause for possible dismissal and/or discharge. I also understand that I am to abide by all rules and regulations of the company. The company has my authorization to thoroughly investigate my work and personal history. I understand that the information supplied by me, regarding my: Employment History, Education (including an authorization to release transcripts), Credit History, Criminal History, Medical and Professional Licensing, Motor Vehicle Record(s), Residence History, and References, will be utilized as part of the processing procedure. A background check will be conducted to verify the veracity of the information submitted and will be utilized to develop information concerning my character, general reputation, personal characteristics, and mode of living. I will hold no person liable for giving or receiving information in this investigation. I hereby authorize that: TR Information Services, an agent of Kalamazoo College, may be asked to make a thorough check of my credit history, driving history, criminal history, past employment, education, and activities. A copy of this form is as valid as the original. I authorize and consent.Signature Δ Summary of your rights under the Fair Credit Reporting Act
