Background Check Authorization and Personal Disclosure

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CTS recognizes that the personal integrity, emotional health, and spiritual maturity of students are critical to our mission to form disciples of Jesus Christ for church and community leadership to serve God’s transforming of the world. We are also responsible for the character and safety of our seminary community and for the safety of our partner congregations that CTS students may serve as part of their seminary education. For these reasons, CTS requires background checks for all students and asks students to complete this Personal Disclosure Form. A student will be subject to denial of admission or dismissal if the student fails to disclose or misrepresents his or her history on the Form and those omissions or misrepresentations are reasonably believed to cast doubt upon the student’s suitability for theological study and ministry. Please note that a past record is not necessarily a bar to studying at CTS. Each situtation will be addressed individually with care and understanding.

Personal Information

Personal Disclosure

Have you ever been charged with, convicted of, pleaded guilty to, or received deferred adjudication for any crime or misdemeanor, other than minor traffic violations? *
Do you have pending, or have you ever sustained, civil, criminal, administrative, or other disciplinary complaints against you for sexual or other misconduct? *
Have you ever resigned, withdrawn, or been terminated from a position or educational program for reasons related to sexual or other misconduct? *

Background Check

CTS recognizes that the personal integrity, emotional health, and spiritual maturity of students are critical to our mission to form disciples of Jesus Christ for church and community leadership to serve God’s transforming of the world.  We are also responsible for the character and safety of our seminary community and for the safety of our partner congregations and ministries that CTS students may serve as part of their seminary education.  For these reasons, CTS will order a “consumer report” (a background report) or “investigative consumer report" on you in connection with your enrollment as a student at CTS.

The background check company, ADP Screening and Selection Services, will prepare the background report for CTS.  ADP Screening and Selection Services is located at 301 Remington Street, Fort Collins, CO, 80524, and can be reached by phone at 800-367-5933 or at their Internet Web site address www.adpselect.com.

The background report may contain information concerning your character, general reputation, personal characteristics, mode of living, and credit standing.  The types of information that may be ordered include but are not limited to:  Social Security number verification; criminal, public, educational and, as appropriate, driving records checks; verification of prior employment; reference, licensing and certification checks; credit reports; or drug testing results. CTS may order a background report under your legal name and any other names you may have used.  Credit history will only be requested when permitted by law and where such information is substantially related to your enrollment in a degree program.  The information may be obtained from private and public record sources, including personal interviews with your associates, friends, and neighbors.  (An “investigative consumer report” is a background report that includes information from such personal interviews, except in California where that term means any background report that is not a credit report.)  The nature and scope of the most common form of investigative consumer report is an investigation into your education and/or employment history conducted by ADP Screening and Selection Services or another outside organization.

You may request more information about the nature and scope of an investigative consumer report by telephoning CTS at 317-931-2300. The Fair Credit Reporting Act gives you specific rights in dealing with consumer reporting agencies. You will find these rights summarized in the Summary of Your Rights Under the Fair Credit Reporting Act, which is included with this form.

 

STATE LAW NOTICES

If you live in the states listed below, please note the following:

CALIFORNIA:  You may view the file that ADP Screening and Selection Services has for you, and order a copy of the file, upon submitting proper identification and paying copying costs, by coming to their offices, during normal business hours and on reasonable notice, or by certified mail or mail.  You may also ask for a file-summary by telephone.  ADP Screening and Selection Services can answer questions about information in your file, including any coded information.  If you come in person, another person can come with you, so long as that person can show proper identification.

MAINE:  If you ask us, you have the right to know whether CTS ordered an investigative consumer report on you.  You may request the name, address, and telephone number of the nearest office for ADP Screening and Selection Services.  You will get this information within 5 business days of our receipt of your request.  You have the right to ask ADP Screening and Selection Services for a free copy of the report.

MARYLAND: If CTS obtains credit history information on you, it will be used to evaluate whether you would present an unacceptable risk of theft or other dishonest behavior as a student.

MASSACHUSETTS/NEW JERSEY:  If you submit a request to us in writing, you have the right to know whether CTS ordered an investigative consumer report from ADP Screening and Selection Services.  You may inspect and order a free copy of the report by contacting ADP Screening and Selection Services. 

MINNESOTA:  If you submit a request to us in writing, you have the right to get from CTS a complete and accurate disclosure of the nature and scope of the consumer report or investigative consumer report ordered, if any.

NEW YORK:  If you submit a request to us in writing, you have the right to know whether CTS ordered a consumer report or an investigative consumer report from ADP Screening and Selection Services, and you will be provided with the name and address of ADP Screening and Selection Services.  You may inspect and order a free copy of the reports by contacting ADP Screening and Selection Services.  By signing below, you certify you have received a copy of Article 23A of the New York Correction Law is being provided with this form.

OREGON:  If CTS obtains credit history information on you, it will be used to evaluate whether you would present an unacceptable risk of theft or other dishonest behavior as a student.

WASHINGTON STATE:  If you submit a request to us in writing, you have the right to get from CTS a complete and accurate disclosure of the nature and scope of the investigative consumer report we ordered, if any.  You also have the right to ask ADP Screening and Selection Services for a written summary of your rights under the Washington Fair Credit Reporting Act.  If CTS obtains information bearing on your credit worthiness, credit standing or credit capacity, it will be used to evaluate whether you would present an unacceptable risk of theft or other dishonest behavior in the job for which you are being considered.

The information requested below is collected solely for the purpose of aiding CTS in running a background check in connection with your enrollment. CTS requests that you provide this information to assist in conducting a thorough background check.

Identification for Background Check

calendar
Enter any other names used (including maiden name(s)):
List all addresses in the past seven (7) years.

Address #1

Address #2

Address #3

Do you have another address to report?

Address #4

Do you have another address to report?

Address #5

Do you have another address to report?

Address #6

Background Check Summary of Rights

A Summary of Your Rights Under the Fair Credit Reporting Act

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

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 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 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 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 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 over $10 billion and their affiliates.

b. Such affiliates that are not banks, savings associations, or credit unions also should list, in addition to the CFPB:

 

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

 

b.  Federal Trade Commission: Consumer Response Center – FCRA, 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 and federal agencies of foreign banks

b.      State member banks, branches and agencies of foreign banks (other than federal branches, federal agencies, and Insured State Branches of Foreign Banks), commercial lending companies owned or controlled 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 Banks, and insured state savings associations

d.      Federal Credit Unions

 

 

 

a. Office of the Comptroller of the Currency,    Customer Assistance Group, 1301 McKinney Street, Suite 3450, Houston, TX 77010-9050

 

b. Federal Reserve Consumer Help Center, P.O. Box 1200, Minneapolis, MN 55480

 

 

c.  FDIC Consumer Response Center, 1100 Walnut Street, Box # 11, Kansas City, MO 64106

 

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 the Surface Transportation Board

Office of Proceedings, Surface Transportation Board, Department of Transportation, 395 E Street, S.W., Washington, DC 20423

5. Creditors Subject to the 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, 409 Third Street, SW, 8th Floor, Washington, DC 20416

7. Brokers and Dealers

Securities and Exchange Commission, 100 F Street, N.E., Washington, DC 20549

8. Federal Land Banks, Federal Land Bank Associations, Federal Intermediate Credit Banks, and Production Credit Associations

 

Farm Credit Administration, 1501 Farm Credit Drive, McLean, VA  22102-5090

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

FTC Regional Office for region in which the creditor operates or Federal Trade Commission: Consumer Response Center – FCRA, Washington, DC 20580, (877) 382-4357

Background Check Authorization

After carefully reading this Background Check Disclosure and Authorization form, I agree to the following: (you must check each box)

I authorize *
I authorize *
I agree *
If you live in California, Minnesota or Oklahoma, check the box below if you would like a free copy of your background investigation.

Sign and Submit Form

Please review your answers carefully.  Once you submit the form, you will not be able to edit it.  When you are ready, sign your name below then click the submit button to send the form to Christian Theological Seminary. You will receive an email confirmation that the form has been sent. If you have any questions please email admissions@cts.edu or call 317-931-2300.  Thank you.
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