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Get DHS 11000-9 2003

Although the disclosure of your SSN is not mandatory your failure to do so may impede the acquisition of a credit report concerning you and possibly result in the denial of your being approved for access to classified and/or sensitive but unclassified information. DHS Form 11000-9 10-03. Rev001 RESET U* S* Department of Homeland Security DISCLOSURE AND AUTHORIZATION PERTAINING TO CONSUMER REPORTS PURSUANT TO THE FAIR CREDIT REPORTING ACT This is a release for the U* S* Department of Homeland Security to obtain one or more consumer/credit reports about you in connection with your application for employment or in the course of your employment with the Department. One or more reports about you may be obtained for employment purposes including evaluating your fitness for employment promotion reassignment retention or access to classified information and/or sensitive but unclassified information* I hereby authorize the U* S* Department of Homeland Security to obtain such report s from any consumer/credit reporting agency for employment purposes. Copies of this authorization that show my signature are as valid as the original signed by me. Signature Date Social Security Number Current Organization Assigned The Privacy Act 5 U*S*C. 552a requires that federal agencies inform individuals at the time information is solicited from them whether the disclosure is mandatory or voluntary by what authority such information is solicited and what uses will be made of the information* You are hereby advised that authority for soliciting your necessary to conduct and/or obtain a credit report on you. Rev001 RESET U* S* Department of Homeland Security DISCLOSURE AND AUTHORIZATION PERTAINING TO CONSUMER REPORTS PURSUANT TO THE FAIR CREDIT REPORTING ACT This is a release for the U* S* Department of Homeland Security to obtain one or more consumer/credit reports about you in connection with your application for employment or in the course of your employment with the Department. One or more reports about you may be obtained for employment purposes including evaluating your fitness for employment promotion reassignment retention or access to classified information and/or sensitive but unclassified information* I hereby authorize the U* S* Department of Homeland Security to obtain such report s from any consumer/credit reporting agency for employment purposes. One or more reports about you may be obtained for employment purposes including evaluating your fitness for employment promotion reassignment retention or access to classified information and/or sensitive but unclassified information* I hereby authorize the U* S* Department of Homeland Security to obtain such report s from any consumer/credit reporting agency for employment purposes. Copies of this authorization that show my signature are as valid as the original signed by me. Signature Date Social Security Number Current Organization Assigned The Privacy Act 5 U*S*C. Copies of this authorization that show my signature are as valid as the original signed by me. Signature Date Social Security Number Current Organization Assigned The Privacy Act 5 U*S*C. 552a requires that federal agencies inform individuals at the time information is solicited from them whether the disclosure is mandatory or voluntary by what authority such information is solicited and what uses will be made of the information* You are hereby advised that authority for soliciting your necessary to conduct and/or obtain a credit report on you. .

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