CONSUMER REPORT DISCLOSURE

In connection with your application for employment, and strictly for the permissible use of employment purposes, Cortech, LLC, and/or its affiliates, including, but not limited to, Cortech West Staffing LLC, and JobStalker – CR, LLC (collectively the “Company”), may request background information about you from the below consumer reporting agency.

Choice Screening

Address: 8668 Concord Center Drive, Englewood, CO 80112

Phone: 720-***-****

Email: ad3ljk@r.postjobfree.com

Website: www.choicescreening.com

This information may be obtained in the form of consumer reports and/or investigative consumer reports. These reports may contain information about your character, general reputation, personal characteristics and mode of living, whichever are applicable. Additionally, these reports may contain information obtained from private and public sources, including, without limitation and as appropriate: government agencies and courthouses, educational institutions, employers, and other public and private record/data repositories. Also, the nature and scope of the reports may contain information about you relating to your: criminal history, character, general reputation, personal characteristics, mode of living, litigation history, and credit history (only if allowed under law), driving and/or motor vehicle records, court records, military records, social security verification, education verification, employment and earnings history, drug/alcohol testing results and history, professional licenses, credentials and certifications, alias history, or current and/or previous addresses. Also, these reports may be obtained after receipt of your authorization and may also be shared with the Company’s Client (i.e., the company where you will be working).

By signing below, you acknowledge you have read and received this Consumer Report Disclosure.

Applicant Printed Name Date

Applicant Signature

CONSUMER REPORT AUTHORIZATION

Under the Fair Credit Reporting Act, I authorize Cortech, LLC, and/or its affiliates, including, but not limited to, Cortech West Staffing LLC, and JobStalker – CR, LLC (collectively the “Company”) to obtain and rely upon consumer reports or investigative consumer reports from the below consumer reporting agency for employment, promotion, reassignment, and retention purposes with the Company.

Choice Screening

Address: 8668 Concord Center Drive, Englewood, CO 80112

Phone: 720-***-****

Email: ad3ljk@r.postjobfree.com

Website: www.choicescreening.com

By my signature below, I authorize the complete release of these records or data pertaining to me that an individual, company, firm, corporation, or public agency may have.

To this end, I authorize, without reservation, any state or federal law enforcement agency or court, educational institution, motor vehicle record agency, credit bureau or other information service bureau or data repository, or employer to furnish any and all information regarding me to the Company and/or the above consumer reporting agency.

Further, I authorize the Company to obtain any reports and data regarding me and to share the information received with any person involved in the Company’s employment decision about me.

By my Signature blow, I certify the information I provided on this form is true and correct. I agree that this Authorization form in original, faxed, photocopied or electronic (including electronically signed) will be valid for any reports that may be requested by or on behalf of the Company.

Applicant Printed Name:

Applicant Signature: Date:

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