DISCLOSURE NOTICE AND AUTHORIZATION CONCERNING CONSUMER REPORTS FOR
EMPLOYMENT APPLICANTS AND EMPLOYEES
PLEASE READ THIS DISCLOSURE NOTICE AND AUTHORIZATION CAREFULLY BEFORE SIGNING THIS FORM. YOU WILL BE PROVIDED A COPY OF THIS FORM AT ANY TIME UPON REQUEST.
I.This form is to notify you that as part of the procedure for processing your employment application, and, if you are employed, during the course of your employment, Safran Seats USA LLC (or the “Company”) may perform and may request and review consumer reports. A “consumer report” is any written, oral, or other communication by a consumer reporting agency bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living, which is used, expected to be used, or collected in whole or in part for the purpose of serving as a factor in establishing your eligibility for employment.
II.The kinds of consumer that may be requested, include, but are not limited to, summaries of educational and employment records, driving records and motor vehicle reports, credit reports/history, internal and external investigations, criminal records background checks, military history, professional credentials and licenses, personal references checks, and court records background checks.
III.The Company may make consumer reports or cause such reports to be made on its behalf, in the Company’s sole discretion, pursuant to federal laws and regulations and applicable state laws. The information contained in these reports may be obtained from public or private record sources or through personal interviews. Except where otherwise prohibited by applicable law, any information contained in such reports may be taken into consideration in evaluating your suitability for employment, promotion, reassignment or retention.
●Note to Applicants for Employment in Texas: Unless you are seeking a position that will be making $75,000 or more per year, or is reasonably expected to equal $75,000 per year or more, or hold such position currently, any information pertaining to civil judgments, tax liens, and most credit report information contained in any consumer report or investigative consumer report obtained by the Company will not date back more than seven (7) years from the date of the report. The “seven-year” restriction does not apply to positions earning $75,000 per year or more.
●Note to Applicants for Employment in Michigan: The Company will not, in connection with the terms, conditions, or privileges of employment or membership request, make or maintain a record or information regarding a misdemeanor arrest, detention, or disposition where a conviction did not result.
●Note to Applicants for Employment in Nevada: Except as otherwise provided by a specific statute, any information pertaining to a civil judgment, report of criminal proceedings, or other adverse information will not date back more than seven (7) years from the date of the report.
IV.If any adverse employment decision is made as to your application for employment or subsequent employment with the Company based on the information contained in a consumer report prepared by a consumer reporting agency, you will be notified and given a copy of the report, as well as a summary of your applicable rights. If you have filed for bankruptcy, no employment decision will be based solely on this information.
V.Your consent is required by law before the Company may request a consumer reporting agency to make a consumer report during the processing of your application and, if hired, at any time during your employment. Your signature below indicates that you have carefully read and understand that the Company may perform and may request and review a consumer report regarding you, consistent with this notice, both in connection with your application for employment and, if hired, during the course of your employment. Further, your signature indicates that you consent to the release of such consumer reports to the Company for employment purposes, including any future decisions concerning your employment, promotion, reassignment or retention as an employee of the Company. Your signature additionally reflects your understanding that such consent will remain in effect indefinitely until you revoke it in writing using the attached form.
VI.Refusal to consent to a consumer report as required by this notice and the Company’s policies, or any other attempt to interfere or failure to cooperate with the Company’s lawful investigation of an applicant or employee, may result in rejection of an application, withdrawal of an offer of employment or discipline, up to and including termination from employment.
AUTHORIZATION STATEMENT
I have carefully read and understand this notice and authorization form. By my signature below, I authorize the performance of, the procurement of, and the release of consumer, as defined above, to the Company in connection with my application for employment. I further understand that this authorization will apply during the course of my employment with the Company should I obtain such employment, and that such authorization will remain in effect until revoked in a written document in the attached form signed by me. I further understand that any and all information contained in my job application or otherwise disclosed to the Company by me, including through this authorization form, may be utilized for the purpose of obtaining the consumer reports requested by the Company and I confirm that all such information is true and correct.
I further hereby authorize all of the following, without limitation, to disclose information about me to a consumer reporting agency such as TriCor Employment Screening (“TriCor”), and its agents in connection with its preparation of background reports on me for the Company:
●law enforcement and all other federal, state and local agencies;
●learning institutions (including public and private schools, colleges and universities);
●testing agencies;
●information service bureaus;
●credit bureaus;
●record/data repositories;
●courts (federal, state and local);
●motor vehicle records agencies;
●my past or present employers;
●the military; and
●all other individuals and sources with any information about or concerning me.
Applicant Last NameLabra FirstFrancisco Middle
Applicant Signature FranciscoLabra Date4/16/2024
IDENTIFYING INFORMATION FOR CONSUMER REPORTING AGENCY
Last Name: _Labra First Name: Francisco Middle:
Other Names Used: Years Used:
Current Address:
205 tripp trl Street /P. O. Box City Denton State tx Zip Code76207 County Dates
Former Address:
Street /P. O. Box City State Zip Code County Dates
*Social Security Number: 340 78 6939 Daytime Phone Number:940-***-****
E-mail Address:****************@*****.*** Driver’s License 27024388 Number:
State of Issuance:tx
*Date of Birth: 03/14/1960 *GenderM
* This information will be used only for background screening purposes and will not be taken into consideration in any employment decisions.
REFUSAL OR REVOCATION OF AUTHORIZATION
I do not consent to the Company performing or requesting consumer reports about me in connection with my application for employment or any other employment purposes. If I have previously granted my consent, I hereby revoke it and understand that such revocation will take effect immediately after the Company receives this written revocation and has actual knowledge of it sufficient to communicate the revocation to those employees or agents of the Company who perform or request consumer reports or investigative consumer reports for the Company.
Social Security Number
Name of Applicant / Employee (Printed)
Applicant/Employee Signature
Date