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Information Personal

Oakland, California, United States
November 20, 2018

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Your Name, State of Residence and State of Employment

khum khan

I currently live in the state of CA and will be working in the state of CA Disclosure of Background Investigation

In conjunction with your application for employment, promotion, reassignment, retention, volunteer position, work to be performed under contract or third party assignment, and/or qualifying for a business transaction ("Engagement"), ATR International Inc ("Company") will use the services of an outside consumer reporting agency and may obtain a

"consumer report" or "investigative consumer report" about you including information relating to your personal background, character, general reputation, personal characteristics, professional standing, work history and qualifications, and/or mode of living. This agency will provide a written report of its findings to Company. Company uses Employment Screening Resources ("ESR"), a consumer-reporting agency, to perform its Engagement related background investigations. ESR utilizes various sources of information to conduct a background check that may include but are not limited to: criminal records, civil records, current and former employers, department of motor vehicle records ("driving records"), military records, credit reports, education records, professional and personal references, government databases such as sex offender listings, Office of Inspector General (OIG) and System for Award Management (SAM) excluded parties lookups, and where it applies to the position; drug testing and MRO services, and/or DOT regulated employer inquiries made in compliance with 49 CFR 382.413 and/or Pilot Records Improvement Act inquiries in compliance with 14 CFR parts 121, 125 and 135.

Rights and Acknowledgments

I acknowledge receipt of the FCRA summary of rights I acknowledge receipt of the NOTICE PURSUANT TO CALIFORNIA LAW I acknowledge receipt of Employee Rights under San Francisco Police Code Article 49.pdf. CALIFORNIA, MINNESOTA AND OKLAHOMA APPLICANTS AND EMPLOYEES: To receive a free copy of any employer requested Reports by email, please enter a valid, private email address in the box below. I may also request a copy of employer requested reports in person, or by writing to Employment Screening Resources (ESR), 7110 Redwood Blvd., Suite C, Novato, CA 94945, or by calling 888-***-****.

Note: If you are not a resident of CA, MN or OK, and would like a copy of your report, please contact ATR International Inc or ESR as outlined above. Authorization and Consent to Background Investigation By electronically signing my name below, I hereby agree, authorize and consent to the procurement of a Consumer Report and/or an Investigative Consumer Report about me by ATR International Inc. I understand that this report may contain information about my character, general reputation, personal characteristics, and/or mode of living. I agree, authorize and consent to the release and disclosure of any and all information about me by ESR to ATR International Inc. Where ATR International Inc is pursuing my direct or temporary Engagement with a third party, that third party may also receive a copy of my report. I also authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, insurance company or other party to furnish any and all background information requested by ESR for the purpose of providing a report to ATR International Inc. This authorization electronically signed by me shall be valid from the date of execution and throughout any subsequent Engagement as allowable by law. I agree that a copy of this document by fax or other electronic means shall be as valid as the original.

Signed By: khum khan

Date 3/14/2016

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