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DISCLOSURE
[IMPORTANT -- PLEASE READ CAREFULLY BEFORE SIGNING AUTHORIZATION]
DISCLOSURE REGARDING BACKGROUND INVESTIGATION
Eastridge Workforce Solutions ("the Company"), on its own behalf and on behalf of the Company's customers and clients, may obtain information about you from a third party consumer reporting agency in connection with your employment application and for employment purposes with the Company, or in connection with employment purposes with the Company's customers and clients on a direct hire basis. Thus, you may be the subject of a "consumer report" and/or an "investigative consumer report" which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources such as your neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records ("driving records"), and verification of your education or employment history, employment references or other background checks. Credit history will only be requested where such information is substantially related to the duties and responsibilities of the position for which you are applying and in accordance with applicable state and federal law. You have the right, upon written request made within a reasonable time after receipt of this notice, to inspect and request disclosure of the nature and scope of any investigative consumer report and to receive a full and free copy of any report about you by contacting First Advantage Background Services Corp. ("First Advantage"), P.O. Box 105292, Atlanta, GA 30348,1-800-***-****. Additionally, you have the right to request additional disclosures and information on the nature of the consumer report or investigative consumer report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment is an investigation into your education and/or employment history conducted by First Advantage Background Services Corp. ("First Advantage"), P.O. Box 105292, Atlanta, GA 30348,1-800-***-****. The scope of this notice and authorization is all-encompassing, however, allowing the Company, on its own behalf and on behalf of the Company's customers and clients, to obtain from any outside organization all manner of consumer reports and investigative consumer reports now and throughout the course of your employment with the Company or with the Company's customers and clients, as applicable, to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report. ACKNOWLEDGMENT AND AUTHORIZATION
I acknowledge receipt of (a) the DISCLOSURE REGARDING BACKGROUND INVESTIGATION; (b) A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT; (c) A Summary of Your Rights Under the California Civil Code Section 1786.22 (if applicable); (d) A SUMMARY OF YOUR RIGHTS UNDER WASHINGTON STATE LAW (if applicable), and (e) Article 23-A of the New York Correction Law (if applicable) and certify that I have read and understand those documents. I hereby authorize the obtaining of and disclosure of "consumer reports" and/or "investigative consumer reports" by and to the Company or by and to the Company's customers and clients for direct hire purposes, if applicable, at any time after receipt of this authorization and throughout my employment with the Company or Company's customers and clients, as applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by First Advantage P.O. Box 105292 Atlanta, GA 30348, 1-800-***-****, another outside organization acting on behalf of the Company, Company's customers and clients, and/or the Company itself. Their Privacy Policy can be reviewed at http://www.fadv.com/privacy-policy/. I also understand that information contained in my job application or otherwise disclosed by me before or during my employment with Company (or before or during my employment with Company's customers and clients on a direct hire basis), if any, may be used for the purpose of obtaining "consumer reports" and/or "investigative consumer reports. I agree that a facsimile ("fax"), electronic or photographic copy of this Acknowledgement and Authorization shall be as valid as the original.
VOLUNTARY CONSENT FOR DISCLOSURE OF BACKGROUND CHECK REPORTS TO THIRD PARTIES FOR BUSINESS PURPOSES
Given the business nature of Eastridge Workforce Solutions (the "Company"), some third parties, such as the Company's customers and clients, require the Company to verify and/or disclose background check reports, including "consumer reports," "investigative consumer reports" and "consumer credit reports" solely for purposes of verifying eligibility for employment/assignment with the Company or with Company's customers and clients on a direct hire basis. The Company respects individual privacy. However, complying with such requirements is simply a reality of doing business in Company's industry. Accordingly, the Company is asking you to consent to the disclosure of your background check reports by the Company to third parties solely for purposes of verifying eligibility for employment/assignment with the Company or Company's customers and clients on a direct hire basis, as applicable, by signing where indicated. NOTE: If you decline to provide consent, the Company will not be able to staff you on certain accounts/assignments with the Company or provide you with employment opportunities with Company's customers and clients on a direct hire basis, but you will remain eligible for consideration for other accounts/assignments with the Company or employment opportunities with Company's customers and clients on a direct hire basis. I voluntarily consent to the disclosure of background check reports about me by the Company to third parties, including Company's customers and clients for purposes of verifying eligibility for employment/assignment with the Company, or with Company's customers and clients on a direct hire basis, without further notice to me, and understand and agree that my consent is good throughout and after my term of employment/engagement with the Company or with Company's customers and clients on a direct hire basis, as applicable.
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A Summary of Your Rights Under the Fair Credit Reporting Act 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.ftc.gov/credit or write to: Consumer Response Center, Room 130-A, Federal Trade Commission, 600 Pennsylvania Ave. N.W., Washington, D.C. 20580.
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, by September 2005 all consumers will be entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.ftc.gov/credit 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 www.ftc.gov/credit 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.
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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 www.ftc.gov/credit.
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 1-888-5-OPTOUT (1-888-***-****). 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 www.ftc.gov/credit.
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 consumer protection agency or your state Attorney General. Federal enforcers are: TYPES OF BUSINESS: CONTACT:
Consumer reporting agencies, creditors and
others not listed below
Federal Trade Commission: Consumer Response
Center - FCRA
Washington, DC 20580 Phone:1-877-***-****
National banks, federal branches/agencies of
foreign banks (word "National" or initials "N.A."
appear in or after bank's name)
Office of the Comptroller of the Currency
Compliance Management
Mail Stop 6-6, Washington, DC 20219 Phone:
Federal Reserve System member banks (except
national banks, and federal branches/agencies of
foreign banks)
Federal Reserve Consumer Help, PO Box 1200,
Minneapolis, MN 55480 Phone:888-***-****
Web: federalreserveconsumerhelp.gov Email:
ac4snz@r.postjobfree.com
Savings associations & federally chartered
savings banks (word "Federal" or initials "F.S.B." appear in federal institution's name)
Office of Thrift Supervision Consumer Complaints
Washington, DC 20552
Phone:800-***-****
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Para informacion en espanol, visite www.ftc.gov/credit o escribe a la FTC Consumer Response Center, Room 130-A 600 Pennsylvania Ave. N.W., Washington, D.C. 20580. California - A Summary of Your Rights Under California Law Under California law, you are entitled, upon presentation of proper identification, to find out from an investigative "consumer reporting agency" ("CRA") what is in your file, as follows: In person, by visual inspection of your file during normal business hours and on reasonable notice; By obtaining a summary of it via telephone call, if you have made a written request, with proper identification, for telephone disclosure and the toll charge, if any, for the telephone call is prepaid by you or charged directly to you; or
By requesting in writing, with proper identification, that a copy of it be sent to a specified addressee by certified mail.
Investigative CRAs complying with requests for certified mailings shall not be liable for disclosures to third parties caused by mishandling of mail after such mailings leave the investigative CRAs. You also may request a copy of the information in person. The CRA may not charge you more than the actual copying costs for providing you with a copy of your file. The investigative CRA will provide trained personnel to explain any information furnished to you and will provide a written explanation of any coded information contained in files maintained on you. This written explanation will be provided whenever a file is provided to you for visual inspection. You may be accompanied by one other person of your choosing, who must furnish reasonable identification. An investigative CRA may require you to furnish a written statement granting permission to the CRA to discuss your file in such person's presence. Federal credit unions (words "Federal Credit
Union" appear in institution's name)
National Credit Union Administration 1775 Duke
Street, Alexandria, VA 22314
Phone 703-***-****
State-chartered banks that are not members of
the Federal Reserve System
Federal Deposit Insurance Corporation Consumer
Response Center
2345 Grand Avenue, Suite 100 Kansas City,
Missouri 64108-2638 Phone: 1-877 -275-3342
Air, surface, or rail common carriers regulated by former Civil Aeronautics Board or Interstate
Commerce Commission
Department of Transportation, Office of Financial Management Washington, DC 20590
Phone: 202-***-****
Activities subject to the Packers and Stockyards
Act, 1921
Department of Agriculture Office of Deputy
Administrator ï 1 2 GIPSA Washington, DC 20250
Phone: 202-***-****
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8. The term "proper identification" as used above shall mean that information generally deemed sufficient to identify a person. Such information includes documents such as a valid driver's license, social security account number, military identification card, and credit cards. Only if the consumer is unable to reasonably identify himself with the information described herein, may an investigative CRA require additional information concerning your employment and personal or family history in order to verify your identity. California - Notice Regarding Credit Checks:
Pursuant to Section 1024.5 of the California Labor Code, the Company may obtain a credit report about you from the above named entity if you are seeking to work in any of the following positions: A position covered by the executive exemption set forth in subparagraph (1) of paragraph (A) of Section 1 of Wage Order 4 of the Industrial Welfare Commission; A position in the state Department of Justice;
A sworn peace officer or other law enforcement;
A position for which the information contained in the report is required by law to be disclosed or obtained; A position that involves regular access to specified personal information for any purpose other than the routine solicitation and processing of credit card applications in a retail establishment, such as bank or credit card account information, social security number, or date of birth; A position which the person can enter into financial transactions on behalf of the company; A position that involves access to confidential or proprietary information; or A position that involves regular access to $10,000 or more of cash. Vermont - Notice Regarding Credit Checks:
Pursuant to Vermont Act No. 154 (S. 95), the Company informs you that it may obtain a credit report about you, for any of the following reason(s):
FOR QUESTIONS OR CONCERNS
REGARDING
PLEASE CONTACT
CRAs and creditors
California Attorney General's Office Public Inquiry Unit
P.O. Box 944255
Sacramento, CA 94244-2550
CRAs and creditors
California Department of Consumer Affairs
400 R Street, Suite 1080
Sacramento, CA 95814
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The information is required by state or federal law or regulation; You seek to be/are employed in a position that involves access to "confidential financial information"
(defined as "sensitive financial information of commercial value that a customer or client of the employer gives explicit authorization for the employer to obtain, process, and store and that the employer entrusts only to managers or employees as a necessary function of their job duties"); The Company is a financial institution as defined in 8 V.S.A. §11101(32) or a credit union as defined in 8 V.S.A. §30101(5);
You seek to be/are employed in a position as a law enforcement officer, emergency medical personnel or firefighter as these terms are respectively defines in 20 V.S.A. §2358, 24 V.S.A. §2651(6) and 20 V.S.A.
§3151(3);
You seek to be/are employed in a position that requires a financial fiduciary responsibility to the Company or a Company's clients, including the authority to issue payments, collect debts, transfer money or enter into contracts;
You seek to be/are employed in a position that involves access to the Company's payroll information; or The Company can demonstrate that credit information is a valid and reliable predictor of employee performance in the your specific position of employment. State of Washington - Consumer Credit Reporting Act Summary Of Consumer Rights The State of Washington Fair Credit Reporting Act (WFCRA) 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 WFCRA. The WFCRA is modeled after the Federal Fair Credit Reporting Act. The same rights are provided under the Federal Fair Credit Reporting Act and you have received A Summary of Your Rights Under the Federal Fair Credit Reporting Act. You can get the complete text of WFCRA RCW 19.182, from the Washington Code Revisers Office, P.O. Box 40551, Olympia, WA, 98504, or online at
http://apps.leg.wa.gov/rcw/default.aspx?cite=19.182&full=true#19.182.070. You must be told if information in your file has been used against you. If a person takes an adverse action against you that is based, in whole or in part, on information contained in a consumer report, that person must tell you, and must give you the name, address, and telephone number of the consumer reporting agency that provided the information.
You have a 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, although medical information may be withheld and given directly to your medical provider. You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You will not be charged for: a consumer report if a person has taken adverse action against you because of information in your credit report;
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the reinvestigation of information you dispute; or Corrected reports resulting from the deletion of inaccurate or unverifiable information. In addition, you are entitled to one free consumer report every 12 months, upon request. You may be charged a limited fee for a second or subsequent report requested by you during a 12 month period. You have a right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and you notify the consumer reporting agency directly of the dispute, the consumer reporting agency will reinvestigate without charge and record the current status of the disputed information before the end of thirty business days, unless your dispute is frivolous. Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Upon completion of the reinvestigation, if the information you disputed is found to be inaccurate or cannot be verified, the consumer reporting agency will delete the information and notify you of the correction. If the reinvestigation does not resolve your dispute, you may file with the consumer reporting agency a brief statement setting forth the nature of your dispute. The statement will be placed in your consumer file and in any subsequent report containing the information you disputed. 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 ten years old.
Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need ï 1 2 usually to consider an application with a creditor, insurer, employer, landlord, or other business. The WFCRA specifies those with a valid need for access. You must be notified if reports are provided to employers. A consumer reporting agency may not give out information about you to employers without your knowledge. A potential employer must make a clear and conspicuous disclosure in writing to you or obtain your consent before obtaining a report. A current employer may not receive a report unless it has given you written notice that consumer reports may be used for employment purposes.
You may limit "prescreened" offers of credit and insurance you get based on information in your credit report. You may elect not to receive unsolicited "prescreened" offers for credit and insurance by using the consumer reporting agency's notification system to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-5-OPTOUT (1-888-567- 8688).
You may place a security freeze on your credit report. A security freeze prevents your credit file from being shared with potential creditors or insurance companies. You may request a security freeze by contacting us by phone at 1-800-***-****, online by visiting https://personalreports.lexisnexis.com/contacts.jsp mail, or by mail by writing to the LexisNexis Consumer Center; ATTN: Security Freeze; P.O. Box 105108; Atlanta, 1.
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Georgia 30348-5108. We may charge a fee for providing this service. You may be able to block information resulting from identity theft from appearing on your credit report. If you are a victim of identity theft, a consumer reporting agency must permanently block misinformation resulting from that theft from appearing on your credit report. You must provide the consumer reporting agency with a copy of a police report as evidence of your claim before it can place the block on your report. 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 WFCRA, you may be able to sue in state or federal court.
COMPLAINTS
Any complaints by consumers under state law may be directed to: Office of the Attorney General
Consumer Protection Division
800 5th Avenue, Suite 2000
Seattle, Washington 98104-3188
Phone 1-800-***-**** or 206-***-****
Fax 206-***-****
Statewide Toll-Free TDD: 800-***-****
Complaints May Be Made Via U.S. Mail or E-Mail Complaints: http://www.atg.wa.gov/FileAComplaint.aspx
(Include your U.S. Mail address with any complaint.) Website & Forms: http://www.atg.wa.gov/
New York Correction Law Article 23-A - Licensure and Employment of Persons Previously Convicted of One or More Criminal Offenses
Section 750. Definitions.
751. Applicability.
752. Unfair discrimination against persons previously convicted of one or more criminal offenses prohibited. 753. Factors to be considered concerning a previous criminal conviction; presumption. 754. Written statement upon denial of license or employment. 755. Enforcement.
§ 750. Definitions. For the purposes of this article, the following terms shall have the following meanings:
"Public agency" means the state or any local subdivision thereof, or any state or local department, agency, board or commission.
"Private employer" means any person, company, corporation, labor organization or association which employs ten or more persons.
"Direct relationship" means that the nature of criminal conduct for which the person was convicted has a direct bearing on his fitness or ability to perform one or more of the duties or responsibilities necessarily 4.
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related to the license, opportunity, or job in question.
"License" means any certificate, license, permit or grant of permission required by the laws of this state, its political subdivisions or instrumentalities as a condition for the lawful practice of any occupation, employment, trade, vocation, business, or profession. Provided, however, that "license" shall not, for the purposes of this article, include any license or permit to own, possess, carry, or fire any explosive, pistol, handgun, rifle, shotgun, or other firearm.
"Employment" means any occupation, vocation or employment, or any form of vocational or educational training. Provided, however, that "employment" shall not, for the purposes of this article, include membership in any law enforcement agency.
§751. Applicability. The provisions of this article shall apply to any application by any person for a license or employment at any public or private employer, who has previously been convicted of one or more criminal offenses in this state or in any other jurisdiction, and to any license or employment held by any person whose conviction of one or more criminal offenses in this state or in any other jurisdiction preceded such employment or granting of a license, except where a mandatory forfeiture, disability or bar to employment is imposed by law, and has not been removed by an executive pardon, certificate of relief from disabilities or certificate of good conduct. Nothing in this article shall be construed to affect any right an employer may have with respect to an intentional misrepresentation in connection with an application for employment made by a prospective employee or previously made by a current employee.
§ 752.Unfair discrimination against persons previously convicted of one or more criminal offenses prohibited. No application for any license or employment, and no employment or license held by an individual, to which the provisions of this article are applicable, shall be denied or acted upon adversely by reason of the individual's having been previously convicted of one or more criminal offenses, or by reason of a finding of lack of "good moral character" when such finding is based upon the fact that the individual has previously been convicted of one or more criminal offenses, unless: There is a direct relationship between one or more of the previous criminal offenses and the specific license or employment sought or held by the individual; or The issuance or continuation of the license or the granting or continuation of the employment would involve an unreasonable risk to property or to the safety or welfare of specific individuals or the general public.
§ 753.Factors to be considered concerning a previous criminal conviction; presumption. In making a determination pursuant to section seven hundred fifty-two of this chapter, the public agency or private employer shall consider the following factors: The public policy of this state, as expressed in this act, to Encourage the licensure and employment of persons previously convicted of one or more criminal offenses.
The specific duties and responsibilities necessarily related to the license or employment sought or held by the person.
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The bearing, if any, the criminal offense or offenses for which the person was previously convicted will have on his fitness or ability to perform one or more such duties or responsibilities. The time which has elapsed since the occurrence of the criminal offense or offenses. The age of the person at the time of occurrence of the criminal offense or offenses. The seriousness of the offense or offenses.
Any information produced by the person, or produced on his behalf, in regard to his rehabilitation and good conduct.
The legitimate interest of the public agency
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