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1 Consumer Dispute In accordance with FCRA guidelines, your dispute investigation will be completed within thirty days. A Trusted Employees representative will contact you if we require further information to process your dispute. If you have not received a reply within 30 days, please call us at You can submit the dispute via fax ( ), (disputes@rhris.com) or mail: Trusted Employees 701 5th Street South Provide Your Information Please provide us with your current information below. Your personal information is required in order for us to properly process your dispute. First Name M.I. Last Name Street Address City State Zip Social Security Number Date of Birth Address Primary Phone Sections Disputing Please indicate which section(s) of the report are you disputing. For each section you choose, you will need to provide details about the record. Please check all that apply: Criminal Record History Employment Verification Driving History Education Verification Sex Offender Records File # (located at the top of your report)

2 Criminal Records Please provide details on the criminal record(s) you are disputing. Docket # or Offense Description State County Offense Type Disposition (e.g. convicted, open, dismissed) Disposition Date Docket # or Offense Description State County Offense Type Disposition (e.g. convicted, open, dismissed) Disposition Date Docket # or Offense Description State County Offense Type Disposition (e.g. convicted, open, dismissed) Disposition Date

3 Employment Verification Please provide details on the Employment Verification record(s) you are disputing. Employer Name Position reported is incorrect Start/End Dates of employment is/are incorrect Salary is incorrect Employer Name Position reported is incorrect Start/End Dates of employment is/are incorrect Salary is incorrect Employer Name Position reported is incorrect Start/End Dates of employment is/are incorrect Salary is incorrect

4 Consumer Dispute Driving History Please provide details on the Driving History record(s) you are disputing. Driver's License State of Issue Driver's License Number Driver's License State of Issue Driver's License Number Driver's License State of Issue Driver's License Number

5 Consumer Dispute Education Verification Please provide details on the Education Verification record(s) you are disputing. School Name Status reported is incorrect From/To Dates of Enrollment is/are incorrect Degree(s) earned is incorrect School Name Status reported is incorrect From/To Dates of Enrollment is/are incorrect Degree(s) earned is incorrect School Name Status reported is incorrect From/To Dates of Enrollment is/are incorrect Degree(s) earned is incorrect

6 Sex Offense Records Please provide details on the Sex Offense record(s) you are disputing. Offense Description State Offense Description State Offense Description State

7 Information Please provide details on the item you are disputing. Item Disputing Describe in detail the information on the item you are disputing Item Disputing Describe in detail the information on the item you are disputing Item Disputing Describe in detail the information on the item you are disputing

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