Fill in Your Employment Application Pdf Template Get Document Here

Fill in Your Employment Application Pdf Template

The Employment Application PDF form is a standardized document used by employers to collect essential information from job applicants. This form typically includes sections for personal details, work history, education, and references. Completing this form accurately is crucial for making a strong first impression in your job search, so take the time to fill it out thoroughly by clicking the button below.

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Key takeaways

When filling out and using the Employment Application PDF form, consider these key takeaways:

  1. Read Instructions Carefully: Always start by reviewing any instructions provided with the application. This ensures you understand the requirements and format expected by the employer.
  2. Provide Accurate Information: Ensure that all details you enter are correct. Inaccuracies can lead to disqualification or mistrust from potential employers.
  3. Be Honest: Always present your qualifications and experiences truthfully. Misrepresentation can have serious consequences, including job termination.
  4. Use Clear and Concise Language: When describing your work experience and skills, use straightforward language. This makes it easier for hiring managers to understand your qualifications.
  5. Highlight Relevant Experience: Tailor your application to emphasize experiences and skills that are most relevant to the job you are applying for.
  6. Check for Errors: Before submitting your application, proofread it for spelling and grammatical mistakes. A polished application reflects professionalism.
  7. Save a Copy: After filling out the application, save a copy for your records. This can be helpful for future reference or follow-up communications.
  8. Submit on Time: Be mindful of deadlines. Submit your application as early as possible to demonstrate your enthusiasm for the position.
  9. Follow Up: After submitting your application, consider following up with the employer. A polite inquiry shows your continued interest in the position.

Dos and Don'ts

When filling out an Employment Application PDF form, attention to detail is crucial. Here are some important dos and don'ts to keep in mind:

  • Do read the entire application before starting to fill it out.
  • Do provide accurate and truthful information.
  • Do use clear and legible handwriting if filling it out by hand.
  • Do double-check for any spelling or grammatical errors.
  • Don't leave any sections blank unless instructed to do so.
  • Don't provide false information to enhance your qualifications.
  • Don't use slang or informal language in your responses.
  • Don't forget to sign and date the application before submission.

Form Overview

Fact Name Description
Purpose The Employment Application PDF form is used by employers to gather information from job applicants.
Common Sections This form typically includes sections for personal information, employment history, education, and references.
Legal Compliance Employers must ensure that the form complies with federal and state employment laws, including anti-discrimination laws.
Signature Requirement Many applications require a signature to verify that the information provided is accurate and truthful.
Data Privacy Employers must handle the information collected on the form in accordance with data privacy laws, ensuring confidentiality.
State-Specific Forms Some states may have specific requirements or forms that must be used, such as California's Fair Employment and Housing Act.
Online Availability Many employers provide the Employment Application PDF form online, allowing applicants to download and fill it out digitally.
Submission Methods Applicants can typically submit the completed form via email, mail, or in person, depending on the employer's preference.
Review Process Employers review the applications to shortlist candidates for interviews based on the information provided.
Record Keeping Employers are often required to keep records of applications for a certain period, as mandated by various employment laws.

Common mistakes

  1. Incomplete Information: Many applicants fail to fill out all required fields. Leaving sections blank can lead to automatic disqualification.

  2. Inaccurate Dates: Some individuals provide incorrect employment dates or educational timelines. This can create discrepancies that may raise red flags during the review process.

  3. Typos and Errors: Spelling mistakes and grammatical errors can detract from the professionalism of the application. Such oversights may give the impression of carelessness.

  4. Failure to Tailor the Application: Applicants often submit the same application for multiple positions without adjusting their qualifications or experiences to match the job requirements. This lack of customization can reduce the chances of being noticed.

  5. Neglecting to Review: Skipping the final review of the application before submission is a common mistake. Taking the time to double-check the entire form can prevent many of the issues mentioned above.

Similar forms

The Employment Application form is similar to a resume in that both documents provide a summary of an individual's work history, education, and skills. While a resume is typically a one or two-page document tailored to a specific job, the employment application often requires more detailed information. This includes references and sometimes even questions about the applicant's background. Both serve the purpose of presenting a candidate's qualifications to potential employers.

Another document that shares similarities with the Employment Application is the Cover Letter. A cover letter complements a resume or application by providing a narrative about the applicant's interest in the position and the company. It allows candidates to express their personality and motivation, which is often less evident in the structured format of an application. Both documents aim to persuade the employer of the applicant's suitability for the job.

The Job Offer Letter is also comparable to the Employment Application. Once a candidate has been selected, a job offer letter outlines the terms of employment, including salary, benefits, and job responsibilities. While the employment application is filled out by the candidate, the job offer letter is generated by the employer. Both documents are crucial in the hiring process, ensuring that both parties understand the expectations and agreements made.

In addition to the various forms and documents related to job applications, individuals may also find it beneficial to obtain an Emotional Support Animal Letter form, especially if they rely on the companionship of their pets for emotional well-being. This letter serves as an important verification of the need for an emotional support animal, helping to ensure necessary accommodations in both housing and travel situations.

Similar to the Employment Application is the Background Check Authorization form. This document is often required by employers to verify the information provided by the applicant. While the application collects initial data, the background check form gives employers permission to conduct further investigations into the candidate's history. Both documents are essential in the vetting process, ensuring that the candidate is a good fit for the organization.

The Reference List is another document that parallels the Employment Application. Candidates typically provide references who can vouch for their skills and character, often listed on the application itself. While the application may request this information, the reference list is a separate document that includes detailed contact information and the relationship between the candidate and their references. Both documents help employers assess the applicant's qualifications and reliability.

Additionally, the Employment Verification form bears similarities to the Employment Application. This document is used to confirm an applicant's previous employment, including job titles, dates of employment, and reasons for leaving. While the application provides this information initially, the verification form serves to ensure accuracy. Both documents are critical for employers to validate the claims made by the candidate.

The Skills Assessment form can also be compared to the Employment Application. This document may be used to evaluate specific competencies related to the job. While the application lists skills, the assessment often requires candidates to demonstrate their abilities through tests or questionnaires. Both documents help employers gauge whether a candidate possesses the necessary skills for the position.

Finally, the Tax Form, such as the W-4, is another document that is related to the Employment Application. While the application focuses on the qualifications of the candidate, the tax form is necessary for payroll purposes once employment is confirmed. Both documents are integral to the employment process, ensuring that the employer has the necessary information to comply with tax regulations.

Other PDF Forms

Your Questions, Answered

What is the Employment Application PDF form?

The Employment Application PDF form is a document that job seekers fill out to apply for positions within a company. This form typically collects essential information such as personal details, work history, education, and references. It serves as a formal introduction to potential employers, allowing them to assess the qualifications of applicants.

How do I fill out the Employment Application PDF form?

Filling out the Employment Application PDF form is straightforward. Here are some steps to guide you:

  1. Download the PDF form from the company’s website or request it from the hiring manager.
  2. Open the PDF using a compatible program that allows you to fill in fields, such as Adobe Acrobat Reader.
  3. Carefully enter your personal information, including your name, address, and contact details.
  4. List your employment history, starting with your most recent job. Include the name of the company, your job title, and the dates of employment.
  5. Provide information about your education, including the names of schools attended and any degrees earned.
  6. Finally, review the form for accuracy before saving it and submitting it as instructed.

What should I do if I make a mistake on the form?

If you notice a mistake after filling out the Employment Application PDF form, don’t worry. Here’s what you can do:

  • If you have not yet submitted the form, simply correct the error directly in the PDF file.
  • If you have already submitted the form, it’s best to contact the hiring manager or HR department. Explain the mistake and provide the correct information.

Can I submit the Employment Application PDF form electronically?

Yes, many companies allow electronic submissions of the Employment Application PDF form. After filling it out, you can save the file and email it to the designated contact. Be sure to check the application instructions provided by the employer, as they may have specific requirements for submission. If the company prefers printed applications, print the form and mail it to the specified address.

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APPLICATION FOR EMPLOYMENT

 

 

(Pre-Employment Questionnaire) (An Equal Opportunity Employer)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PERSONAL INFORMATION

 

 

 

 

 

 

 

DATE

 

 

 

 

 

 

 

 

 

 

 

 

LAST

 

 

 

 

 

 

 

 

 

 

 

SOCIAL SECURITY

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME

 

 

 

 

 

 

 

 

NUMBER

 

 

 

 

LAST

FIRST

 

 

 

MIDDLE

 

 

 

 

 

 

 

PRESENT ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET

CITY

 

 

 

STATE

ZIP

 

 

PERMANENT ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET

CITY

 

 

 

STATE

ZIP

 

 

 

 

 

 

 

 

 

PHONE NO.

ARE YOU 18 YEARS OR OLDER?

 

Yes q

No q

 

 

ARE YOU PREVENTED FROM LAWFULLY BECOMING EMPLOYED

 

 

 

 

 

 

 

 

 

 

 

IN THIS COUNTRY BECAUSE OF VISA OR IMMIGRATION STATUS?

 

Yes q

 

 

 

No q

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYMENT DESIRED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE YOU

 

 

 

 

SALARY

 

 

POSITION

 

 

CAN START

 

 

 

 

DESIRED

FIRST

 

 

 

 

 

IF SO MAY WE INQUIRE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ARE YOU EMPLOYED NOW?

 

OF YOUR PRESENT EMPLOYER?

 

 

EVER APPLIED TO THIS COMPANY BEFORE?

 

WHERE?

 

 

 

 

WHEN?

 

 

REFERRED BY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EDUCATION

 

 

 

 

*NO OF

 

*DID YOU

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME AND LOCATION OF SCHOOL

 

YEARS

 

 

 

SUBJECTS STUDIED

 

 

 

 

 

 

 

ATTENDED

 

GRADUATE?

 

 

 

 

 

 

 

GRAMMAR SCHOOL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MIDDLE

 

HIGH SCHOOL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COLLEGE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TRADE, BUSINESS OR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CORRESPONDENCE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SCHOOL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GENERAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUBJECTS OF SPECIAL STUDY OR RESEARCH WORK

 

 

 

 

 

 

 

 

 

 

 

 

 

SPECIAL SKILLS

ACTlVITIES: (CIVIC ATHLETIC ETC.)

EXCLUDE ORGANIZATIONS, THE NAME OF WHICH INDICATES THE RACE, CREED. SEX. AGE, MARITAL STATUS, COLOR OR NATION OF ORIGIN OF ITS MEMBERS.

U. S MILITARY OR

 

PRESENT MEMBERSHIP IN

NAVAL SERVICE

RANK

NATIONAL GUARD OR RESERVES

*This form has been revised to comply with the provisions of the Americans with Disabilities Act and the fnal regulations and interpretive guidance promulgated by the EEOC on July 26. 1991.

TOPS FORM 3285 (92-8)

(CONTINUED ON OTHER SIDE)

LITHO IN U.S.A.

FORMER EMPLOYERS (LIST BELOW LAST THREE EMPLOYERS, STARTING WITH LAST ONE FIRST).

DATE

NAME AND ADDRESS OF EMPLOYER

SALARY POSITION REASON FOR LEAVING

MONTH AND YEAR

 

 

FROM

TO

FROM

TO

FROM

TO

FROM

TO

WHICH OF THESE JOBS DlD YOU LIKE BEST?

WHAT DlD YOU LIKE MOST ABOUT THIS JOB?

REFERENCES: GIVE THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR.

NAME

ADDRESS

BUSINESS

YEARS

ACQUAINTED

 

 

 

1

2

3

THE FOLLOWING STATEMENT APPLIES IN: MARYLAND & MASSACHUSETTS. [Fill in name of state.)

IT IS UNLAWFUL IN THE STATE OF ________________________ TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST

AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITY.

Signature of Applicant

IN CASE OF

EMERGENCY NOTIFY

NAME

ADDRESS

PHONE NO.

"I CERTIFY THAT ALL THE INFORMATION SUBMITTED BY ME ON THIS APPLICATION IS TRUE AND COMPLETE, AND I UNDERSTAND THAT IF ANY FALSE INFORMATION, OMISSIONS, OR MISREPRESENTATIONS ARE DISCOVERED, MY APPLICATION MAY BE REJECTED AND, IF I AM EMPLOYED. MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME.

IN CONSIDERATION OF MY EMPLOYMENT, I AGREE TO CONFORM TO THE COMPANY'S RULES AND REGULATIONS, AND I AGREE THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE. AND WITH OR WITHOUT NOTICE, AT ANY TIME, AT EITHER MY OR THE COMPANY'S OPTION. I ALSO UNDERSTAND AND AGREE THAT THE TERMS AND CONDITIONS OF MY EMPLOYMENT MAY BE CHANGED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME BY THE COMPANY. I UNDERSTAND THAT NO COMPANY REPRESENTATIVE, OTHER THAN IT'S PRESIDENT, AND THEN ONLY WHEN IN WRONG AND SIGNED BY THE PRESIDENT, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING.

DATE

SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

DO NOT WRITE BELOW THIS LINE

 

INTERVIEWED BY:

 

DATE:

REMARKS:

 

 

 

 

 

 

 

NEATNESS

 

ABILITY

 

HIRED: q Yes

q No

POSITION

DEPT.

SALARY/WAGE

 

DATE REPORTING TO WORK

 

APPROVED:

1.

2.

3

 

EMPLOYMENT MANAGER

DEPT. HEAD

GENERAL MANAGER

This form has been designed to strictly comply with State and Federal fair employment practice laws prohibiting employment discrimination. This Application for Employment Form is sold for general use throughout the United States. TOPS assumes no responsibility for the inclusion in said form of any questions which, when asked by the Employer of the Job Applicant, may violate State and/or Federal Law.

We welcome your application for employment at Southern Platte Fire Protection District (hereinafter referred to as the Company). We are proud that our success is the result of the quality and caliber of our employees. In pursuit of excellence, we require, as a condition of employment, all applicants must consent to and authorize a pre-employment verification of the background information submitted on their applications and resumes.

The following information is used for identification

purposes in verifying background information.

Printed Name______________________ Date__________

Signature________________________________________

SS#____________________________________________

List any cities and states where you previously resided:

_________________________________________________

_________________________________________________

_________________________________________________

_________________________________________________

DISCLOSURE AND AUTHORIZATION [IMPORTANT -- PLEASE READ CAREFULLY BEFORE SIGNING AUTHORIZATION]

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

(“the Company”) may obtain information about you for employment 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, and which can involve personal interviews with sources such as your neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal history, social security number validation, motor vehicle records (“driving records”), verification of your education or employment history, or other background checks. Credit history will only be requested where such information is substantially related to the duties and responsibilities of the position for which you are applying. You have the right, upon written request made within a reasonable time, to request whether a consumer report has been requested and compiled 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 employment is an investigation into your education and/or employment history conducted by Validity Screening Solutions, PO Box 860443, Shawnee, KS 66286-0443, 866.915.0792, www.validityscreening.com, 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 employment 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 or employees only: You have the right to inspect and receive a copy of any investigative consumer report requested by

by contacting the consumer reporting agency identified above directly. You may also contact the Company to request the name, address and telephone number of the nearest unit of the consumer reporting agency designated to handle inquiries, which the Company shall provide within 5 days.

New York applicants or employees only: Upon request, you will be informed whether or not a consumer report was requested by , and if such 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 the Company has not maintained secured records is 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 understand both of those documents. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by the Company at any time after receipt of this authorization and throughout my employment, 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, employer, or insurance company to furnish any and all background information requested by Validity Screening Solutions, PO Box 860443, Shawnee, KS 66286-0443, 866.915.0792, www.validityscreening.com, another outside organization acting on behalf of the Company, and/or the Company itself. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original.

New York applicants or employees only: By signing below, you also acknowledge receipt of Article 23-A of the New York Correction Law.

Minnesota and Oklahoma applicants or employees only: Please check this box if you would like to receive a copy of a consumer report if one is obtained by the

Company.

(Must include email address:

 

)

 

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 the Company whenever you have a right to receive such a copy under California law. www.validityscreening.com/Site/PrivacyPolicy

(Must include email address:

)

Signature:

 

Date:

 

BACKGROUND INFORMATION

Last Name

Other Names/Alias

Social Security # [1][2]

Driver’s License # [2]

Present Address

City/State/Zip

First Middle

Date of Birth (mm/dd/yyyy) [1][2]

State of Driver’s License [2]

Telephone # (Primary)

[1]This information will be used for background screening purposes only and will not be used as hiring criteria.[2] In Utah, this information may only be collected a) when extending a conditional offer of employment or b) at the time the background report will be run.

3

V 1.0 (Issued: November 2012)

Para información en español, visite www.consumerfinance.gov/learnmore o escribe a la

Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.

A Summary of Your Rights Under the Fair Credit Reporting Act

The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to www.consumerfinance.gov/learnmore or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.

You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment – or to take another adverse action against you – must tell you, and must give you the name, address, and phone number of the agency that provided the information.

You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your “file disclosure”). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:

a person has taken adverse action against you because of information in your credit report;

you are the victim of identity theft and place a fraud alert in your file;

your file contains inaccurate information as a result of fraud;

you are on public assistance;

you are unemployed but expect to apply for employment within 60 days.

In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.consumerfinance.gov/learnmore for additional information.

You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender.

You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See www.consumerfinance.gov/learnmore for an explanation of dispute procedures.

Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate.

Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old.

Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need – usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access.

You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to www.consumerfinance.gov/learnmore.

You may limit “prescreened” offers of credit and insurance you get based on information in your credit report. Unsolicited “prescreened” offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888- 567-8688.

You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.

Identity theft victims and active duty military personnel have additional rights. For more information, visit www.consumerfinance.gov/learnmore.

States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. For information about your federal rights, contact:

TYPE OF BUSINESS:

CONTACT:

1.a. Banks, savings associations, and credit unions with total assets of

a. Consumer Financial Protection Bureau

over $10 billion and their affiliates.

1700 G Street NW

 

Washington, DC 20552

b. Such affiliates that are not banks, savings associations, or credit

b. Federal Trade Commission: Consumer Response Center – FCRA

unions also should list, in addition to the CFPB

Washington, DC 20580

 

(877) 382-4357

2. To the extent not included in item 1 above:

 

a. National banks, federal savings associations, and federal branches

a. Office of the Comptroller of the Currency

and federal agencies of foreign banks

Customer Assistance Group

 

1301 McKinney Street, Suite 3450

 

Houston, TX 77010-9050

b. State member banks, branches and agencies of foreign banks (other

b. Federal Reserve Consumer Help Center

than federal branches, federal agencies, and Insured State Branches of

P.O. Box 1200

Foreign Banks), commercial lending companies owned or controlled

Minneapolis, MN 55480

by foreign banks, and organizations operating under section 25 or 25A

 

of the Federal Reserve Act

 

c. Nonmember Insured Banks, Insured State Branches of Foreign

c. FDIC Consumer Response Center

Banks, and insured state savings associations

1100 Walnut Street, Box #11

 

Kansas City, MO 64106

d. Federal Credit Unions

d. National Credit Union Administration

 

Office of Consumer Protection (OCP)

 

Division of Consumer Compliance and Outreach (DCCO)

 

1775 Duke Street

 

Alexandria, VA 22314

3. Air carriers

Asst. General Counsel for Aviation Enforcement & Proceedings

 

Aviation Consumer Protection Division

 

Department of Transportation

 

1200 New Jersey Avenue, S. E.

 

Washington, DC 20590

4. Creditors Subject to Surface Transportation Board

Office of Proceedings, Surface Transportation Board

 

Department of Transportation

 

395 E Street, S.W.

 

Washington, DC 20423

5. Creditors Subject to Packers and Stockyards Act. 1921

Nearest Packers and Stockyards Administration area supervisor

 

 

6. Small Business Investment Companies

Associate Deputy Administrator for Capital Access

 

United States Small Business Administration

 

406 Third Street, SW, 8th Floor

 

Washington, DC 20416

7. Brokers and Dealers

Securities and Exchange Commission

 

100 F St, N.E.

 

Washington, DC 20549

8. Federal Land Banks, Federal Land Bank Associations, Federal

Farm Credit Administration

Intermediate Credit Banks, and Production Credit Associations

1501 Farm Credit Drive

 

McLean, VA 22102-5090

9. Retailers, Finance Companies, and All Other Creditors Not Listed

FTC Regional Office for region in which the creditor operates or

Above

Federal Trade Commission: Consumer Response Center – FCRA

 

Washington, DC 20580

 

(877) 382-4357

(Updated: November 2012)

Para información en español, visite www.consumerfinance.gov/learnmore o escribe a la Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.

Remedying the Effects of Identity Theft

You are receiving this information because you have notified a consumer reporting agency that you believe you are a victim of identity theft. Identity theft occurs when someone uses your name, Social Security number, date of birth, or other identifying information, without authority, to commit fraud. For example, someone may have committed identity theft by using your personal information to open a credit card account or get a loan in your name. For more information, visit www.consumerfinance.gov/learnmore or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.

The Fair Credit Reporting Act (FCRA) gives you specific rights when you are, or believe that you are, the victim of identity theft. Here is a brief summary of the rights designed to help you recover from identity theft.

1.You have the right to ask that nationwide consumer reporting agencies place “fraud alerts” in your file to let potential creditors and others know that you may be a victim of identity theft. A fraud alert can make it more difficult for someone to get credit in your name because it tells creditors to follow certain procedures to protect you. It also may delay your ability to obtain credit. You may place a fraud alert in your file by calling just one of the three nationwide consumer reporting agencies. As soon as that agency processes your fraud alert, it will notify the other two, which then also must place fraud alerts in your file.

Equifax: 1.888.766.0008; www.equifax.com

Experian: 1.888.397.3742; www.experian.com

TransUnion: 1.800.680.7289; www.transunion.com

An initial fraud alert stays in your file for at least 90 days. An extended alert stays in your file for seven years. To place either of these alerts, a consumer reporting agency will require you to provide appropriate proof of your identity, which may include your Social Security number. If you ask for an extended alert, you will have to provide an identity theft report. An identity theft report includes a copy of a report you have filed with a federal, state, or local law enforcement agency, and additional information a consumer reporting agency may require you to submit. For more detailed information about the identify theft report, visit www.consumerfinance.gov/learnmore.

2.You have the right to free copies of the information in your file (your “file disclosure”). An initial fraud alert entitles you to a copy of all the information in your file at each of the three nationwide agencies, and an extended alert entitles you to two free file disclosures in a 12- month period following the placing of the alert. These additional disclosures may help you detect signs of fraud, for example, whether fraudulent accounts have been opened in your name or whether someone has reported a change in your address. Once a year, you also have

the right to a free copy of the information in your file at any consumer reporting agency, if you believe it has inaccurate information due to fraud, such as identity theft. You also have the ability to obtain additional free file disclosures under other provisions of the FCRA. See www.consumerfinance.gov/learnmore.

3.You have the right to obtain documents relating to fraudulent transactions made or accounts opened using your personal information. A creditor or other business must give you copies of applications and other business records relating to transactions and accounts that resulted from the theft of your identity, if you ask for them in writing. A business may ask you for proof of your identity, a police report, and an affidavit before giving you the documents. It may also specify an address for you to send your request. Under certain circumstances, a business can refuse to provide you with these documents. See www.consumerfinance.gov/learnmore.

4.You have the right to obtain information from a debt collector. If you ask, a debt collector must provide you with certain information about the debt you believe was incurred in your name by an identity thief – like the name of the creditor and the amount of the debt.

5.If you believe information in your file results from identity theft, you have the right to ask that a consumer reporting agency block that information from your file. An identity thief may run up bills in your name and not pay them. Information about the unpaid bills may appear on your consumer report. Should you decide to ask a consumer reporting agency to block the reporting of this information, you must identify the information to block, and provide the consumer reporting agency with proof of your identity and a copy of your identity theft report. The consumer reporting agency can refuse or cancel your request for a block if, for example, you don’t provide the necessary documentation, or where the block results from an error or a material misrepresentation of fact made by you. If the agency declines or rescinds the block, it must notify you. Once a debt resulting from identity theft has been blocked, a person or business with notice of the block may not sell, transfer, or place the debt for collection.

6.You also may prevent businesses from reporting information about you to consumer reporting agencies if you believe the information is the result of identity theft. To do so, you must send your request to the address specified by the business that reports the information to the consumer reporting agency. The business will expect you to identify what information you do not want reported and to provide an identity theft report.

To learn more about identity theft and how to deal with its consequences, visit www.consumerfinance.gov/learnmore, or write to the Consumer Financial Protection Bureau. You may have additional rights under state law. For more information, contact your local consumer protection agency or your state Attorney General.

In addition to the new rights and procedures to help consumers deal with the effects of identity theft, the FCRA has many other important consumer protections. They are described in more detail at www.consumerfinance.gov/learnmore.

(Updated: November 2012)