North Carolina Real Estate Commission Applicants, …

1 North Carolina real Estate CommissionCriminal Record Check Manual Ordering Process | Page1 North Carolina real Estate Commission Applicants, Thank you for contacting (CRC) for your North Carolina real EstateCommission Criminal Record Check. By accessing this document, you have chosen to fax or mail us yourinformation. You may also have lived out of the country and require an international criminal follow the steps below to expedite your North Carolina real Estate Commission Criminal RecordCheck fill out pages 1 thru 7 of this and date page 8 of this to calling our offices, please document the following of Names You Have (County/State) Where You Have Lived within the past seven (7) our offices via telephone for your estimate Free 877-272-0266 X contacting our offices, please document the following Number of Verifications Price here if you would like topay byMoney Order, Certified Check, or Business a Money Order or Business Check for the Total Price your payment and a copy of pages 1 thru 7 of this document , PO Box 90998, Raleigh, NC here if you would like topay by Credit a copy of pages 1 thru 7 of this document to , PO Box90998, Raleigh, NC 27675-0998 or fax to note that we will contact you directly via telephone to obtain payment by creditcard once we have received your requestNorth Carolina real Estate CommissionCriminal Record Check Manual Ordering Process | Page2 Identification Information CollectionPlease provide us with your current name.

2 As well as any other names or name variations you have note that you will be billed for each additional name outside of the state of North Carolina ($ flat fee for all names in North Carolina ).Current Name:_____ (first middle last)Additional Names:_____Date of Birth:_____ ( January 1, 1960)Social Security Number:_____ (123-45-6789)Names as it appears on SSN Card:_____Driver s Licenses Held:Current License:Number: _____ State Issued: _____Additional Licenses:Number: _____ State Issued: _____Number: _____ State Issued: _____Number: _____ State Issued: _____North Carolina real Estate CommissionCriminal Record Check Manual Ordering Process | Page3 Past Address CollectionPlease provide us with addresses where you have lived within the past seven (7) years:Current Address:Address 1_____City _____State/Zip_____County _____Dates _____ (MM/YY MM/YY)Previous Addresses:Address 2_____City _____State/Zip_____County _____Dates _____(MM/YY MM/YY)Address 3_____City _____State/Zip_____County _____Dates _____(MM/YY MM/YY)Address 4_____City _____State/Zip_____County _____Dates _____(MM/YY MM/YY)Address 5_____City _____State/Zip_____County _____Dates _____(MM/YY MM/YY)Address 6_____City _____State/Zip_____County _____Dates _____(MM/YY MM/YY)Address 7_____City _____State/Zip_____County _____Dates _____(MM/YY MM/YY) North Carolina real Estate CommissionCriminal Record Check Manual Ordering Process | Page4 Criminal ConvictionsPlease list all Felony, Misdemeanor, and Criminal Traffic Convictions and Pending Cases below.

3 Do notlist any disposed cases/charges that are categorized as non-convictions. Do not include sealed orexpunged records. Also, do not include juvenile records or records entered into First Offender ProgramsCheck here if you do not have any prior Felony, Misdemeanor, and Criminal Traffic Convictions orPending Cases:Record 1_____Severity_____(Felony, Misdemeanor)Description_____County/State _____Disposition Date _____(MM/YY)Record 2_____Severity_____(Felony, Misdemeanor)Description_____County/State _____Disposition Date _____(MM/YY)Record 3_____Severity_____(Felony, Misdemeanor)Description_____County/State _____Disposition Date _____(MM/YY)Record 4_____Severity_____(Felony, Misdemeanor)Description_____County/State _____Disposition Date _____(MM/YY) North Carolina real Estate CommissionCriminal Record Check Manual Ordering Process | Page5 Disclosure and Authorization[IMPORTANT - - PLEASE READ CAREFULLY BEFORE SIGNING ACKNOWLEDGMENT]NOTICE REGARDING BACKGROUND INVESTIGATIONThe North Carolina North Carolina real Estate Commission ( the Licensing Agency ) may obtaininformation about you from a consumer reporting agency for licensing purposes.

4 Thus, you may be thesubject of a consumer report and/or an investigative consumer report which may includeinformation 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 reports may contain information regarding your criminal history, verification of your licenses,verification of your employment or education, and other background checks. These reports may beobtained at any time after receipt of your authorization. You have the right, upon written request madewithin a reasonable time after receipt of this notice, to request disclosure of the nature of the scope ofany investigative consumer report by (CRC), PO Box 90998,Raleigh, NC 27675, 877-272-0266. The scope of this disclosure is all-encompassing, however, allowingLicensing Agency to obtain from any outside organization all manner of consumer reports andinvestigative consumer reports.

5 As a result, you should carefully consider whether to exercise your rightto request disclosure of the nature and scope of any investigative consumer report. Informationregarding (CRC) s privacy practices (including information about whether anyconsumer personal information will be sent outside the or its territories) may be found and New York applicants only: You have the right to inspect and receive a copy of anyinvestigative consumer report requested by Licensing Agency by contacting the consumerreporting agency identified above AND AUTHORIZATIONI acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARYOF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understandboth of those documents. I hereby authorize the obtaining of consumer report and/or investigativeconsumer reports at any time after receipt of this authorization.

6 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 tofurnish any and all background information requested (CRC). I agree thata facsimile ( fax ) or photographic copy of this Authorization shall be as valid as the Carolina real Estate CommissionCriminal Record Check Manual Ordering Process | Page6 Washington State applicants or employees only: You have the right to receive a complete andaccurate disclosure of the nature and scope of any investigative consumer report as well as a writtensummary of your rights and remedies under the Washington Fair Credit Reporting applicants or employees only: Information describing your rights under federal and Oregonlaw 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 securedrecords is available to you upon York applicants only.

7 By signing below, you hereby acknowledge that you have received and reada copy of Article 23-A of the New York Correction and Oklahoma applicants or employees only: Please check this box if you would like toreceive a copy of a consumer report if one is obtained by the Licensing applicants or employees only: By signing below, you also acknowledge receipt of the NOTICEREGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check this box ifyou would like to receive a copy of an investigative consumer report or consumer credit report if oneis obtained by the Licensing Agency at no charge whenever you have a right to receive such a copyunder California Name (First Middle Last)Date of Birth (MM/DD/YYYY)Driver License Number / StateSocial Security Number (SSN) North Carolina real Estate CommissionCriminal Record Check Manual Ordering Process | Page7 Contact InformationName:_____ (first middle last)Mailing Address:_____City:_____State/Zip:_____Ph one:_____Alternate Phone:_____Fax Report To:_____Email (Optional):_____Special Instructions:_____Security QuestionsPlease answer two (2) of the following four (4) 1:What was your first pet s name?

8 Answer 1:_____Question 2:In what city did you meet your spouse/significant other?Answer 2:_____Question 3:What is your father s middle name?Answer 3:_____Question 4:In what city or town was your first job?Answer 4:_____North Carolina real Estate CommissionCriminal Record Check Manual Ordering Process | Page8 Para informaci n en espa ol, escribe a laConsumer Financial Protection Bureau, 1700 G Street , Washington, DC Summary of Your Rights Under the Fair Credit Reporting ActThe federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy ofinformation in the files of consumer reporting agencies. There are many types of consumerreporting agencies, including credit bureaus and specialty agencies (such as agencies that sellinformation about check writing histories, medical records, and rental history records). Here is asummary of your major rights under the more information, including informationabout additional rights, go write to: ConsumerFinancial Protection Bureau, 1700 G Street , Washington, DC 20552.

9 You must be told if information in your file has been used against who uses acredit report or another type of consumer report to deny your application for credit, insurance, oremployment or to take another adverse action against you must tell you, and must give youthe name, address, and phone number of the agency that provided the information. You have the right to know what is in your may request and obtain all theinformation about you in the files of a consumer reporting agency (your file disclosure ). Youwill be required to provide proper identification, which may include your Social Securitynumber. 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 addition, all consumers are entitled to one free disclosure every 12 months upon request fromeach nationwide credit bureau and from nationwide specialty consumer reporting agencies.

10 Additional information. You have the right to ask for a credit scores are numerical summaries of yourcredit-worthiness based on information from credit bureaus. You may request a credit scorefrom consumer reporting agencies that create scores or distribute scores used in residential realproperty loans, but you will have to pay for it. In some mortgage transactions, you will receivecredit score information for free from the mortgage lender. You have the right to dispute incomplete or inaccurate you identifyinformation in your file that is incomplete or inaccurate, and report it to the consumerreporting agency, the agency must investigate unless your dispute is frivolous. an explanation of dispute Carolina real Estate CommissionCriminal Record Check Manual Ordering Process | Page9 Consumer reporting agencies must correct or delete inaccurate, incomplete, orunverifiable , incomplete or unverifiable information must be removedor corrected, usually within 30 days.