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| # FEDERAL DEPOSIT INSURANCE CORPORATION                               |
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| # Notice and Authorization                                            |
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| **Pertaining to Consumer Reports**                                    |
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| # Pursuan                                                             |
| t to the Fair Credit Reporting Act of 1970, 15 U.S.C. § 1681, et seq. |
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Please take notice that one or more consumer reports may be obtained for
employment purposes. Because a background investigation will be
conducted as part of a determination of your fitness for employment, or
for performance under a contract, you are also entitled to request
additional disclosures concerning the nature and scope of the
investigation.

By signing this form, you are giving consent to have your consumer
reports furnished by consumer reporting agencies as part of an
investigation to determine your (1) fitness for Federal employment, (2)
clearance to perform contractual service, and/or (3) security clearance
or access. The information obtained may be redisclosed to other Federal
agencies for the above purposes and in fulfillment of official
responsibilities to the extent that such disclosure is permitted by law.

This authorization is valid for one (1) year from the date signed or
upon my separation of employment/services from the FDIC.

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  I                                                     hereby

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(Name of Employee/Applicant)

> authorize the Federal Deposit Insurance Corporation to obtain such
> report(s) from any consumer-reporting agency for employment purposes.

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Signature

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Date

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Social Security Number

§

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  Executive Order 9397 (Nov. 22, 1943) asks Federal agencies to use
  Social Security Numbers (SSN) to help identify individuals in agency
  records. Your SSN is therefore needed to keep records accurate, because
  other people may have the same name. Providing your SSN is voluntary.
  However, failure to provide the requested information could result in
  the FDIC receiving an erroneous credit report.

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FDIC 1600/10 (10-02)