Candidate Name: KAMAL SKINNER
CM/BH ID: ********
Client Name: PONTOON/FIELDGLASS/PEPSICO, INC. (I)
Job Applied For: ACCTG OPS ANALYST
Recruiter: ***.***@********.***
Work City/State: ATLANTA, GA
Case ID: 285052606
Consumer Reporting Agency: First Advantage
Order Date: 29/Apr/2024
Date PAA Sent, if applicable: 05/01/24
The below information was obtained from your consumer report and/or self-disclosure. If the information listed is not accurate, stop completing this form and contact the Consumer Reporting Agency to open a dispute.
To be completed by Company Representative
To be completed by the applicant
Charge
Charge Type and Disposition
Disposition Date
Section 1: Circumstances of the event
(include the specifics of the situation, and any details you feel are relevant to our understanding of the situation)
Section 2: Your age at the time the incident occurred
PURCHASE POSSESSION MANUFACTURE DISTRIBUTION OR SALE OF MARIJUANA
MISDEMEANOR Disposition GUILTY
13/Feb/2024
Click to enter text.
Click to enter text.
THEFT BY RECEIVING STOLEN PROPERTY
MISDEMEANOR Disposition CONVICTED
13/Feb/2024
Click to enter text.
Click to enter text.
1.What were the circumstances surrounding the event(s) listed above? Please provide details in the blue column titled “Section 1: Circumstances of the event” above.
2.How old were you at the time? Please provide details in the blue column titled “Section 2: Age at the time” above.
3.Were you sentenced to any jail time, community service, or probation as a result of the above? Please be specific.
Click to enter text.
4.Are you currently on probation or parole? Yes No
a.If so, have you had any probation/parole violations?
i.Date(s), if applicable: Click to enter text.
ii.Details of the violation(s), if applicable: Click to enter text.
5.Have you held employment since the most recent offense(s), or since release (if applicable?) Please provide all information below.
Name of Employer
Position Title
Description of Job Responsibilities
Start and End Date
Click to enter text.
Click to enter text.
Click to enter text.
Click to enter text.
Click to enter text.
Click to enter text.
Click to enter text.
Click to enter text.
Click to enter text.
Click to enter text.
Click to enter text.
Click to enter text.
Click to enter text.
Click to enter text.
Click to enter text.
Click to enter text.
6.Do you have any documentation of rehabilitative efforts or good conduct? If so, please provide any documentation as an attachment when you return this questionnaire and specify which charge, if applicable, it applies to. Examples of such documentation may include: Transcripts, diplomas, certifications or letters from teachers evidencing training or education; References from an employer or job training program; Evidence of participation in counseling program or other workforce development or social service programs; Participation in a state or federal bonding program; Documentation of volunteer activities; etc.
Click to enter text.
7.Do you have additional information that you would like The Company to consider regarding your rehabilitation? Click to enter text.
8.What is the best way to reach you if we have any additional questions?
a.Email Address: Click to enter text.
b.Phone #: Click to enter text.
c.Best days and hours to reach you between 9am and 5pm ET Monday - Friday (please include your time zone): Click to enter text.
i.Please note: If we have questions and need to speak with you, we will contact you by phone at the number you provided above. If we can’t reach you, you will have 48 hours from when we left you a message, or five business days from the date of your pre-adverse action letter (10 business days in Philadelphia or Erie County, PA), whichever is later, to return our call. Please call during our normal business hours of 9am to 5pm Monday-Friday. If we do not hear from you within this timeframe, we will make our decision based on the information currently available to us.
Thank you for your honesty and thoroughness in completing all the information above. Upon receipt of this form, a representative will review your responses and be in touch regarding the status of your employment with the Company.
I certify by typing my name below that the information provided on this form is true and complete. I understand that if I provide false information, or if omissions or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated. The transmission of this document by electronic mail shall constitute effective execution and delivery and may be used in lieu of the original for all purposes.
Signature: Click to enter text. Date: Click to enter text.
At this point, the Company has extended to you a conditional offer of employment. One of the conditions for your employment is a satisfactory criminal background check. Based upon information received from your Criminal Conviction Questionnaire and/or a consumer report from a Consumer Reporting Agency, we have some follow up questions.
It is essential that you answer the following questions about your background so that the Company can consider all factors to determine your suitability for placement. A prior criminal history will not necessarily disqualify you from employment with the Company; however, your prior criminal history will be considered along with other factors, such as the nature and severity of the offense, time that has passed since the offense and/or the completion of the sentence, and the nature of the position you are seeking.
Your answers to the following questions must be truthful, complete, and accurate. If you do not answer the questions honestly, or you only provide part of the information, you may not be eligible for employment opportunities with the Company. When you provide complete and truthful information, the Company will individually assess your prior criminal conduct to determine next steps.
We recommend that you refer to your court records to complete the following questions. In addition, you may want to contact your lawyer, the court, your probation/parole officer, or seek other assistance in completing this form.
For questions about this process or form, please contact ***@********.***.