Broker Check

Disclosure to the Consumer

Acceptance of the Disclosure to the Consumer

{As required by the 1997 FCRA Section 606(a)}

As a routine part of our due diligence effort, Guardian Life Insurance Company Intends to obtain an investigative consumer report on you. To Insure full compliance with the 1997 Fair Credit Reporting Act and to facilitate easy access to all information necessary, please read and sign this form.

I authorize all persons and entities (including but not limited to businesses, corporations, former supervisors, credit agencies, governmental agencies, law enforcement authorities, education institutions, state insurance departments, FINRA, and all military services) to release all written and verbal information about me to ChoicePoint Inc. and/or Applicant Insight. 

I also give my consent for The Guardian Life Insurance Company of America to review previous Uniform Application for Registration (u-4) and Uniform Termination Notice (U-5) information for employment, registration and disciplinary history through FINRA Web-CRD. I understand that a completed U-4 will be necessary for registration. 

I specifically understand and authorized the procurement of an investigative consumer credit report and understand that n all likelihood it will contain information about my background, mode of living, character, general reputation, and personal characteristics. 

I further understand that upon written request I will be given a list of the areas which will be researched and included in the investigative report into my background. I have read and understand the attached summary of my rights under the 1997 Fair Credit Reporting Act. This release, in original or copy form, is valid now or any time in the future. I release all parties from any claims or liability in connection with its review of the above information, I agree with all the provisions shown in this disclosure form and have been provided a copy of this document. 

California, Minnesota, and Oklahoma Residents: 

I understand that this document will be given full legal recognition under the laws of the States of California, Minnesota, and Oklahoma. 

If you wish to have a copy of the report(s) provided at the address provided on the employment application , please notify Interviewer of this request the day of your meeting.