Credit Report Authorization Form By my signature below I, , authorize Q1 FINANCIAL INC to obtain a Background Check and/or Consumer Credit Report on me. This authorization is valid for purposes of verifying information given pursuant to employment, leasing, rental, business negotiations, or any other lawful purpose covered under the Fair Credit Reporting Act (FCRA). The Background Check may contain information available in the Public Domain but may not include interviews with persons other than previous employers or their agents or references for which I have provided. By my signature below, I hereby authorize all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, city, state, county and federal courts and agencies, military services and persons to release all information they may have about me including criminal and driving history. This authorization shall be valid in original or copy form. Applicants Name* Social Security Number * Date of Birth* Mobile Number* Provide Addresses for the Last 7 Years Current Street Address* City* State* Start Date* Prior Street Address City State Start Date End Date Prior Street Address City State Start Date End Date Driver License* State* I do consent and give my authorization for you to obtain employment information, a criminal background check and credit reports for your review and consideration in determining my qualifications for candidacy on the Supervisory Committee of Q1 FINANCIAL INC. Digital Signature* Date* We will charge $35 for the application process. Will call you before processing the application.
