In connection with my application for employment (including contract for services) with (name of your company), I understand that consumer reports which may contain public record information and investigative consumer reports consisting of interviews with employers, neighbors, friends, and associates may be requested from Argus-Search Inc. a consumer reporting agency. These reports may include the following types of information: names of employers and dates of previous employment, reason for termination of employment, work experience, accidents, etc. I further understand that such reports may contain public record information concerning my driving record, workers’ compensation claims, credit, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records. I hereby consent to your obtaining the above information from such agency.
I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY THE CONSUMER REPORTING AGENCY TO FURNISH THE ABOVE-MENTIONED INFORMATION.
I have the right to make a request to (Company Name / Agent Name and address), upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the recipients of any reports on me which the agency has previously furnished within the two year period preceding my request.
I hereby authorize procurement of consumer report(s). If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for you to procure consumer reports and investigative consumer reports at any time during my employment (or contract) period.
I acknowledge receipt of a copy of Article 23-A of New York Correction Law.
Print Name Social Security No.
Applicant’s Signature Date
ARTICLE 23-A
A COPY OF THIS LAW IS BEING PROVIDED TO
YOU IN CONJUNCTION WITH OUR ORDERING BACKGROUND REPORTS ON YOU.
___________________________________________________________________________________
§750. Definitions. For the purposes of this article, the following terms
shall have the following meanings:
(1) “Public agency” means the
state or any local subdivision thereof, or any state or local department,
agency, board or commission.
(2) “Private employer” means
any person, company, corporation, labor organization or association which
employs ten or more persons.
(3) “Direct relationship”
means that the nature of criminal conduct for which the person was convicted
has a direct bearing on his fitness or ability to perform one or more of the
duties or responsibilities necessarily related to the license, opportunity, or
job in question.
(4) “License” means any
certificate, license, permit or grant of permission required by the laws of
this state, its political subdivisions or instrumentalities as a condition for
the lawful practice of any occupation, employment, trade, vocation, business,
or profession. Provided, however, that “license” shall not, for the purposes of
this article, include any license or permit to own, possess, carry, or fire any
explosive, pistol, handgun, rifle, shotgun, or other firearm.
(5) “Employment” means any
occupation, vocation or employment, or any form of vocational or educational
training. Provided, however, that ‘employment” shall not, for the purposes of
this article, include membership in any law enforcement agency.
§751. Applicability. The provisions of this article shall apply to any application by any
person for a license or employment at any public or private employer, who has
previously been convicted of one or more criminal offenses in this state or in
any other jurisdiction, and to any license or employment held by any person
whose conviction of one or more criminal offenses in this state or in any other
jurisdiction preceded such employment or granting of a license, except where a
mandatory forfeiture, disability or bar to employment is imposed by law, and
has not been removed by an executive pardon, certificate of relief from
disabilities or certificate of good conduct. Nothing in this article shall be
construed to affect any right an employer may have with respect to an
intentional misrepresentation in connection with an application for employment
made by a prospective employee or previously made by a current employee.
§752. Unfair discrimination against
persons previously convicted of one or more criminal offenses prohibited. No application for any license or employment, and no
employment or license held by an individual, to which the provisions of this
article are applicable, shall be denied or acted upon adversely by reason of
the individuals having been previously convicted of one or more criminal
offenses, or by reason of a finding of lack of ‘good moral character’ when such
finding is based upon the fact that the individual has previously been
convicted of one or more criminal offenses, unless:
(1) There is a direct
relationship between one or more of the previous criminal offenses and the
specific license or employment sought or held by the individual; or
(2) the
issuance or continuation of the license or the granting or continuation of the
employment would involve an unreasonable risk to property or to the safety or
welfare of specific individuals or the general public.
§753. Factors to be
considered concerning a previous criminal conviction; presumption. 1. In making a determination pursuant to section seven hundred
fifty—two of this chapter, the public agency or private employer shall consider
the following factors:
(a) The public policy of this
state, as expressed in this act, to encourage the licensure and employment of
persons previously convicted of one or more criminal offenses.
(b) The specific duties and
responsibilities necessarily related to the license or employment sought or
held by the person.
(c) The bearing, if any, the
criminal offense or offenses for which the person was previously convicted will
have on his fitness or ability to perform one or more such duties or
responsibilities.
(d) The time which has elapsed
since the occurrence of the criminal offense or offenses.
(e) The age of the person at
the time of occurrence of the criminal offense or offenses.
(f) The seriousness of the
offense or offenses.
(g) Any information produced
by the person, or produced on his behalf, in regard to his rehabilitation and
good conduct.
(h) The legitimate interest of
the public agency or private employer in protecting property, and the safety
and welfare of specific individuals or the general public.
2. In making a determination
pursuant to section seven hundred fifty—two of this chapter, the public agency
or private employer shall also give consideration to a certificate of relief
from disabilities or a certificate of good conduct issued to the applicant,
which certificate shall create a presumption of rehabilitation in regard to the
offense or offenses specified therein.
§754. Written
statement upon denial of license or employment. At the request of
any person previously convicted of one or more criminal offenses who has been
denied a license or employment, a public agency or private employer shall
provide, within thirty days of a request, a written statement setting forth the
reasons for such denial.
§755. Enforcement. 1. In relation to actions by public agencies, the provisions of this
article shall be enforceable by a proceeding brought pursuant to article
seventy—eight of the civil practice law and rules.
2. In relation to actions by private employers, the provisions of this article
shall be enforceable by the division of human rights pursuant to the powers and
procedures set forth in article fifteen of the executive law, and,
concurrently, by the New York city commission on human rights.