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Masterworks/Hidden Treasures Background Investigation Authorization Form
Please read carefully before signing.

The Fair Credit Reporting Act (Amended 1997) has stipulated that we inform you that a background investigation
may be processed as part of our screening and selection process. This investigation may include inquiries to gather
legal information regarding your personal characteristics, mode of living, character and general reputation. This
information, if gathered, is used to verify specific information that you provided on an application, resume, or during
the interview process. Upon your written request, within a reasonable timeframe, the nature and scope of the report,
if one is made, will be provided. In addition, if a report is processed, you have a right to request a copy of the report
from the consumer-reporting agency that provided the report.
The items of personal information requested below are needed to process your background investigation. This
information is intended solely for that purpose and will not be used in a discriminatory manner by the parties noted
below in the making of appropriate staffing decisions. Your information will be kept private.
Print Full Name of Applicant: ____________________________________________________________
(first)
(middle)
(last)
Other names you have used, including maiden names and the date(s) your name(s) changed:

____________________________________________________________________________________________________

Social Security #: ________________________ Your Date of Birth ______/_____/__________
Driver’s License #: _____________________(incl. only if driving truck) State issued in: _________________

Reason for Investigation (please circle)- Applying/Volunteering for: Thrift Store Work Driving Truck

List all your addresses for the past 7 years, starting with most recent: (Must include present address):
Street
From
To
Address
City
State
Country
Zip
Mo/Yr
Mo/Yr








Have you ever been convicted of a crime (other than minor traffic offenses)? Yes: _______ No:______

If yes, please explain charges: (use an additional sheet of paper if necessary): ___________________________________

What state, what country, and what year did these convictions occur? ___________________________________________
I authorize Hidden Treasures Thrift Store/Masterworks of Minneapolis, Oxford Document Management Company
and/or ADP Easy Hire and their agents to investigate my background as it pertains to employment, appointment or
volunteering considerations. This may include information contained in public records which could include credit
history, criminal files at the county, state and federal jurisdiction levels, motor vehicle records and investigations of
employment history. I hereby release all persons, companies or corporations furnishing such information from
liability and responsibility. A copy of this document can be substituted for the original. This document shall be valid
for a period of 1 (one) year from the date of my signature.

Signature of Potential Employee/Volunteer: _____________________________________ Date: __________________