Disclosure New

Community Name

First Name

Middle Name

Last Name

Current Address

City

State

Zip Code

Phone Number

Mobile Phone

Your ever Current

Email Address

DOB

SSN

Have you ever been arrested before?

Identification

We require a copy of your Driver’s License and Social Security Card to verify your name, address, date of birth and social security number.

Upload Government Issued ID (Drivers License, Passport, etc)

Allowed file types: .jpg, .png, .pdf

Upload Government Issued Social Security Card

Allowed file types: .jpg, .png, .pdf

Disclosure

AmeriCheckUSA may search for personal information on you, in regard to your current application for residency, through various databases, which may include, but not limited to, Criminal Records, Eviction Records, Bankruptcies, Liens, Judgements, Lawsuits, etc. AmeriCheckUSA may also obtain a copy of your consumer report, also known as a credit report, through various credit reporting agencies such as Equifax, TransUnion, Experian, which may include your FICO score. AmeriCheckUSA may also conduct personal interviews with your current or prior employers, current or prior landlords, neighbors, friends, or associates to verify information which was submitted on your application. AmeriCheckUSA may share any information obtained, with any person, involved in making a decision about your residency.

Authorization

By signing below, you agree that you have read and understand the foregoing disclosure and hereby authorize AmeriCheckUSA to conduct a full and complete residential background check as described in the above disclosure. You further authorize that AmeriCheckUSA may share any information obtained, with any person, involved in making a decision about your residency.

Disclosure

Authorization

Today's Date

Your Name

Your Signature

Clear Signature