Authorization to Obtain Consumer Report Consumer reports may be obtained as part of the Chicago Metropolitan Fire Prevention Company’s evaluation of my job application/employment. The reports may be procured by Assurance Agency, Ltd., or ADP, LLC and may include my driving record, an assessment of my insurability under the Company’s insurance coverages or other consumer reports. By signing this disclosure, I hereby authorize Assurance Agency, Ltd. Or ADP,LLC to procure such reports and additional reports about me from time to time, as it deems appropriate, to evaluate my insurability or for other permissible purposes. I understand that under no circumstances can Assurance Agency, Ltd. Or ADP, LLC provide a copy or specific details of these reports to the driver or Chicago Metropolitan Fire Prevention Company. A copy of the report can be obtained through the Department of Motor Vehicles. Driver Information: Name of Driver: Street Address: City, State, Zip: Date of Birth: Driver’s License #: State of Issuance: Employer Information: Chicago Metropolitan Fire Prevention Company Applicant/Employee Signature Date Print Full Name
Authorization to Obtain Consumer Report Consumer reports may be obtained as part of the Chicago Metropolitan Fire Prevention Company’s evaluation of my job application/employment. The reports may be procured by Assurance Agency, Ltd., or ADP, LLC and may include my driving record, an assessment of my insurability under the Company’s insurance coverages or other consumer reports. By signing this disclosure, I hereby authorize Assurance Agency, Ltd. Or ADP,LLC to procure such reports and additional reports about me from time to time, as it deems appropriate, to evaluate my insurability or for other permissible purposes. I understand that under no circumstances can Assurance Agency, Ltd. Or ADP, LLC provide a copy or specific details of these reports to the driver or Chicago Metropolitan Fire Prevention Company. A copy of the report can be obtained through the Department of Motor Vehicles. Driver Information: Name of Driver: Street Address: City, State, Zip: Date of Birth: Driver’s License #: State of Issuance: Employer Information: Chicago Metropolitan Fire Prevention Company Applicant/Employee Signature Date Print Full Name
CMFP-Employment-Application.docx