Personal Information
Name Maicol Ramirez
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
Current Address *** * *** **
City, State/Province Zip/Postal Rialto, CA 92376
Country United States
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
SSN/SIN 8465
Date of Birth
10/09/1978
Primary Phone 725-***-****
Email adxlng@r.postjobfree.com
Company Questions
GENERAL INFORMATION
What position are you applying for? Mover/Helper
What location are you applying for?
San Bernardino, CA
Are you legally eligible for employment in
the United States?
Yes
Are you currently employed? No
What date did your last employment end?
Do you read, write, and speak English? Yes
EDUCATION
List highest grade completed: College - 4
List last school attended (name, city, and
state):
San Jose, CR
PERSONAL REFERENCES
List name, address, city, state, phone number, and relationship: First Reference: Rodolfo Lopez. 2744 W Rialto Ave, Ca 909-***-****
Friends
Second Reference: Aura Martinez. Rialto, Ca
Friends
Employment / Unemployment
Elite Riverside, Ca
Company Elite Riverside, Ca
Start Date 06-2022
End Date 07-2022
Address 11600 Cactus Ave
City, State/Province Zip/Postal Riverside, CA 92376 Country United States
Phone 971-***-****
Position Held Warehouse assistent
Reason for leaving? Better options
Were you terminated/discharged/laid off? No
Is this your current employer? No
May we contact this employer at this time? Yes
2
Service Connection
Company Service Connection
Start Date 10-2019
End Date 06-2022
Address
City, State/Province Zip/Postal Ontario, CA 91761
Country United States
Phone 909-***-****
Position Held Driver warehouse
Reason for leaving? Payments wasn t good
Were you terminated/discharged/laid off? No
Is this your current employer? Yes
May we contact this employer at this time? Yes
Staff Chex
Company Staff Chex
Start Date 01-2019
End Date 09-2019
Address Las Vegas
City, State/Province Zip/Postal Las Vegas, NV 89104 Country United States
Phone 702385791
Position Held Manufacturing helper
Reason for leaving? Better options
Were you terminated/discharged/laid off? No
Is this your current employer? No
May we contact this employer at this time? Yes
Signature
Full Name Maicol Ramirez
IP Address 2607:fb91:1195:9
Signature Date/Time 07-14-2022 4:42 PM
3
By signing my application below, I agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature. This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.
Signed Date: 07-14-2022 4:42 PM
Signed:
Federal FCRA Summary of Rights Acknowledgment
By checking this box, I (a) acknowledge
that I have read and understand the
federal FCRA Summary of Rights and
have been given the opportunity to
copy/print the Summary of Rights and (b)
agree to use an electronic signature to
demonstrate my consent. An electronic
signature is as legally binding as an ink
signature.
Yes
CALIFORNIA DISCLOSURE REGARDING BACKGROUND CHECKS DOCUMENT By checking the box, I 1) agree to use an
electronic signature to demonstrate my
consent, 2) agree that an electronic
signature is as legally binding as an ink
signature, and 3) acknowledge that I have
read and understood this California
Disclosure Regarding Background Checks
document.
Yes
California Consumer Copy Request
If you live or work in California, Minnesota,
or Oklahoma, please check this box if
you'd like to receive a copy of a consumer
report if one is obtained.
Yes
FCRA Disclosure and Authorization
By checking the box, I (a) acknowledge
that I have read and understand the above
Yes
4
and also have been given the opportunity
to copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
User Requested Copy
User requested a copy to be sent to this
email address
adxlng@r.postjobfree.com.
Yes
5
AUTHORIZATION FOR CONSUMER REPORTS
I hereby authorize procurement of consumer report(s) and investigative consumer report(s) by Company. If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for Company to procure such reports at any time during my employment or contract period. I authorize without reservation, any person, business or agency contacted by any consumer reporting agency retained by Company to furnish the above-mentioned information. This authorization is conditioned upon the following representations of my rights: I understand that I have the right to make a request to any consumer reporting agency ("Agency") that supplied the report to the Company upon proper identification, to obtain copies of any reports furnished to Company by the Agency and to request the nature and substance of all information in its files on me at the time of my request, including the sources of information, and the Agency, on Company's behalf, will provide a complete and accurate disclosure of the nature and scope of the investigation covered by any investigative consumer report(s). The Agency will also disclose the recipients of any such reports on me which the Agency has previously furnished within the two year period for employment requests, and one year for other purposes preceding my request
(California three years). I hereby consent to Company obtaining the above information from such Agencies. I understand that I can dispute, at any time, any information that is inaccurate in any type of report with the Agency by contacting the Agency directly. I may view the Agency's privacy policy at their website. I understand that I can also contact the Company at 2400 Old Mill Rd., Carrollton, TX 75007, 469-***-**** to request information about the nature of any consumer reports or investigative consumer reports supplied by an Agency.
Agency Contact Information:
HireRight
Attn: Consumers Department
14002 E. 21st Street, Suite 1200
Tulsa, OK 74134
http://www.hireright.com/applicants
iiX
1716 Briarcrest Drive
Suite 200
Bryan, TX 77802
Asurint
Compliance Dept
PO Box 14730
Cleveland, Ohio 44114
Email: adxlng@r.postjobfree.com
Tenstreet
120 W. 3rd Street
Tulsa, OK 74103
adxlng@r.postjobfree.com
As a California applicant, I understand that I have the right under Section 1786.22 of the California Civil Code to contact the Agency during reasonable hours (9:00 a.m. to 5:00 p.m. (CTZ) Monday through Friday) to obtain all information in Agency's file for my review. I may obtain such information as follows: 1) In person at the Agency's offices, which address is listed above or, if not listed above, obtained by contacting Tenstreet by phone. I can have someone accompany me to the Agency's offices. Agency may require this third party to present reasonable identification. I may be required at the time of such visit to sign an authorization for the Agency to disclose to or discuss Agency's information with this third party; 2) By certified mail, if I have previously provided identification in a written 6
request that my file be sent to me or to a third party identified by me; 3) By telephone, if I have previously provided proper identification in writing to Agency; and 4) Agency has trained personnel to explain any information in my file to me and if the file contains any information that is coded, such will be explained to me. I understand that if the report is provided to an employer in the State of Washington, that I can contact the following office for more information regarding my rights under Washington state law in regard to these reports: State of Washington Attorney General, Consumer Protection Division, 800 5th Ave, Ste. 2000, Seattle, Washington 98104-3188, 206-***-****. Printed Name:
Maicol Ramirez
Social Security #:
8465
Signed Date: 07-14-2022
Maicol Ramirez
589 W 2nd St
Rialto, CA 92376
Gender:
7
AUTHORIZATION FOR CONSUMER REPORTS
I hereby authorize procurement of consumer report(s) and investigative consumer report(s) by Company. If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for Company to procure such reports at any time during my employment or contract period. I authorize without reservation, any person, business or agency contacted by any consumer reporting agency retained by Company to furnish the above-mentioned information. This authorization is conditioned upon the following representations of my rights: I understand that I have the right to make a request to any consumer reporting agency ("Agency") that supplied the report to the Company upon proper identification, to obtain copies of any reports furnished to Company by the Agency and to request the nature and substance of all information in its files on me at the time of my request, including the sources of information, and the Agency, on Company's behalf, will provide a complete and accurate disclosure of the nature and scope of the investigation covered by any investigative consumer report(s). The Agency will also disclose the recipients of any such reports on me which the Agency has previously furnished within the two year period for employment requests, and one year for other purposes preceding my request
(California three years). I hereby consent to Company obtaining the above information from such Agencies. I understand that I can dispute, at any time, any information that is inaccurate in any type of report with the Agency by contacting the Agency directly. I may view the Agency's privacy policy at their website. I understand that I can also contact the Company at 2400 Old Mill Rd., Carrollton, TX 75007, 469-***-**** to request information about the nature of any consumer reports or investigative consumer reports supplied by an Agency.
Agency Contact Information:
HireRight
Attn: Consumers Department
14002 E. 21st Street, Suite 1200
Tulsa, OK 74134
http://www.hireright.com/applicants
iiX
1716 Briarcrest Drive
Suite 200
Bryan, TX 77802
Asurint
Compliance Dept
PO Box 14730
Cleveland, Ohio 44114
Email: adxlng@r.postjobfree.com
Tenstreet
120 W. 3rd Street
Tulsa, OK 74103
adxlng@r.postjobfree.com
As a California applicant, I understand that I have the right under Section 1786.22 of the California Civil Code to contact the Agency during reasonable hours (9:00 a.m. to 5:00 p.m. (CTZ) Monday through Friday) to obtain all information in Agency's file for my review. I may obtain such information as follows: 1) In person at the Agency's offices, which address is listed above or, if not listed above, obtained by contacting Tenstreet by phone. I can have someone accompany me to the Agency's offices. Agency may require this third party to present reasonable identification. I may be required at the time of such visit to sign an authorization for the Agency to disclose to or discuss Agency's information with this third party; 2) By certified mail, if I have previously provided identification in a written 8
request that my file be sent to me or to a third party identified by me; 3) By telephone, if I have previously provided proper identification in writing to Agency; and 4) Agency has trained personnel to explain any information in my file to me and if the file contains any information that is coded, such will be explained to me. I understand that if the report is provided to an employer in the State of Washington, that I can contact the following office for more information regarding my rights under Washington state law in regard to these reports: State of Washington Attorney General, Consumer Protection Division, 800 5th Ave, Ste. 2000, Seattle, Washington 98104-3188, 206-***-****. Employer / Contractor / Educational Institution:
Elite Riverside, Ca
Printed Name:
Maicol Ramirez
Social Security #:
8465
Signed Date: 07-14-2022
Maicol Ramirez
589 W 2nd St
Rialto, CA 92376
Gender:
9
AUTHORIZATION FOR CONSUMER REPORTS
I hereby authorize procurement of consumer report(s) and investigative consumer report(s) by Company. If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for Company to procure such reports at any time during my employment or contract period. I authorize without reservation, any person, business or agency contacted by any consumer reporting agency retained by Company to furnish the above-mentioned information. This authorization is conditioned upon the following representations of my rights: I understand that I have the right to make a request to any consumer reporting agency ("Agency") that supplied the report to the Company upon proper identification, to obtain copies of any reports furnished to Company by the Agency and to request the nature and substance of all information in its files on me at the time of my request, including the sources of information, and the Agency, on Company's behalf, will provide a complete and accurate disclosure of the nature and scope of the investigation covered by any investigative consumer report(s). The Agency will also disclose the recipients of any such reports on me which the Agency has previously furnished within the two year period for employment requests, and one year for other purposes preceding my request
(California three years). I hereby consent to Company obtaining the above information from such Agencies. I understand that I can dispute, at any time, any information that is inaccurate in any type of report with the Agency by contacting the Agency directly. I may view the Agency's privacy policy at their website. I understand that I can also contact the Company at 2400 Old Mill Rd., Carrollton, TX 75007, 469-***-**** to request information about the nature of any consumer reports or investigative consumer reports supplied by an Agency.
Agency Contact Information:
HireRight
Attn: Consumers Department
14002 E. 21st Street, Suite 1200
Tulsa, OK 74134
http://www.hireright.com/applicants
iiX
1716 Briarcrest Drive
Suite 200
Bryan, TX 77802
Asurint
Compliance Dept
PO Box 14730
Cleveland, Ohio 44114
Email: adxlng@r.postjobfree.com
Tenstreet
120 W. 3rd Street
Tulsa, OK 74103
adxlng@r.postjobfree.com
As a California applicant, I understand that I have the right under Section 1786.22 of the California Civil Code to contact the Agency during reasonable hours (9:00 a.m. to 5:00 p.m. (CTZ) Monday through Friday) to obtain all information in Agency's file for my review. I may obtain such information as follows: 1) In person at the Agency's offices, which address is listed above or, if not listed above, obtained by contacting Tenstreet by phone. I can have someone accompany me to the Agency's offices. Agency may require this third party to present reasonable identification. I may be required at the time of such visit to sign an authorization for the Agency to disclose to or discuss Agency's information with this third party; 2) By certified mail, if I have previously provided identification in a written 10
request that my file be sent to me or to a third party identified by me; 3) By telephone, if I have previously provided proper identification in writing to Agency; and 4) Agency has trained personnel to explain any information in my file to me and if the file contains any information that is coded, such will be explained to me. I understand that if the report is provided to an employer in the State of Washington, that I can contact the following office for more information regarding my rights under Washington state law in regard to these reports: State of Washington Attorney General, Consumer Protection Division, 800 5th Ave, Ste. 2000, Seattle, Washington 98104-3188, 206-***-****. Employer / Contractor / Educational Institution:
Service Connection
Printed Name:
Maicol Ramirez
Social Security #:
8465
Signed Date: 07-14-2022
Maicol Ramirez
589 W 2nd St
Rialto, CA 92376
Gender:
11
AUTHORIZATION FOR CONSUMER REPORTS
I hereby authorize procurement of consumer report(s) and investigative consumer report(s) by Company. If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for Company to procure such reports at any time during my employment or contract period. I authorize without reservation, any person, business or agency contacted by any consumer reporting agency retained by Company to furnish the above-mentioned information. This authorization is conditioned upon the following representations of my rights: I understand that I have the right to make a request to any consumer reporting agency ("Agency") that supplied the report to the Company upon proper identification, to obtain copies of any reports furnished to Company by the Agency and to request the nature and substance of all information in its files on me at the time of my request, including the sources of information, and the Agency, on Company's behalf, will provide a complete and accurate disclosure of the nature and scope of the investigation covered by any investigative consumer report(s). The Agency will also disclose the recipients of any such reports on me which the Agency has previously furnished within the two year period for employment requests, and one year for other purposes preceding my request
(California three years). I hereby consent to Company obtaining the above information from such Agencies. I understand that I can dispute, at any time, any information that is inaccurate in any type of report with the Agency by contacting the Agency directly. I may view the Agency's privacy policy at their website. I understand that I can also contact the Company at 2400 Old Mill Rd., Carrollton, TX 75007, 469-***-**** to request information about the nature of any consumer reports or investigative consumer reports supplied by an Agency.
Agency Contact Information:
HireRight
Attn: Consumers Department
14002 E. 21st Street, Suite 1200
Tulsa, OK 74134
http://www.hireright.com/applicants
iiX
1716 Briarcrest Drive
Suite 200
Bryan, TX 77802
Asurint
Compliance Dept
PO Box 14730
Cleveland, Ohio 44114
Email: adxlng@r.postjobfree.com
Tenstreet
120 W. 3rd Street
Tulsa, OK 74103
adxlng@r.postjobfree.com
As a California applicant, I understand that I have the right under Section 1786.22 of the California Civil Code to contact the Agency during reasonable hours (9:00 a.m. to 5:00 p.m. (CTZ) Monday through Friday) to obtain all information in Agency's file for my review. I may obtain such information as follows: 1) In person at the Agency's offices, which address is listed above or, if not listed above, obtained by contacting Tenstreet by phone. I can have someone accompany me to the Agency's offices. Agency may require this third party to present reasonable identification. I may be required at the time of such visit to sign an authorization for the Agency to disclose to or discuss Agency's information with this third party; 2) By certified mail, if I have previously provided identification in a written 12
request that my file be sent to me or to a third party identified by me; 3) By telephone, if I have previously provided proper identification in writing to Agency; and 4) Agency has trained personnel to explain any information in my file to me and if the file contains any information that is coded, such will be explained to me. I understand that if the report is provided to an employer in the State of Washington, that I can contact the following office for more information regarding my rights under Washington state law in regard to these reports: State of Washington Attorney General, Consumer Protection Division, 800 5th Ave, Ste. 2000, Seattle, Washington 98104-3188, 206-***-****. Employer / Contractor / Educational Institution:
Staff Chex
Printed Name:
Maicol Ramirez
Social Security #:
8465
Signed Date: 07-14-2022
Maicol Ramirez
589 W 2nd St
Rialto, CA 92376
Gender:
13
A Summary of Your Rights Under the Fair Credit Reporting Act Para informacion en espanol, visite www.consumerfinance.gov/learnmore o escribe a la Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.
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.consumerfinance.gov/learnmore or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552. 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, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.consumerfinance.gov/learnmore 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.consumerfinance.gov/learnmore 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.
·
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.consumerfinance.gov/learnmore.
·
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 form the lists these offers are based on. You may opt out with the nationwide credit bureaus at 1-888-5-OPTOUT (1-888-***-****).
·
14
The following FCRA right applies with respect to nationwide consumer reporting agencies: CONSUMERS HAVE THE RIGHT TO OBTAIN A SECURITY FREEZE You have a right to place a "security freeze" on your credit report, which will prohibit a consumer reporting agency from releasing information in your credit report without your express authorization. The security freeze is designed to prevent credit, loans, and services from being approved in your name without your consent. However, you should be aware that using a security freeze to take control over who gets access to the personal and financial information in your credit report may delay, interfere with, or prohibit the timely approval of any subsequent request or application you make regarding a new loan, credit, mortgage, or any other account involving the extension of credit. As an alternative to a security freeze, you have the right to place an initial or extended fraud alert on your credit file at no cost. An initial fraud alert is a 1-year alert that is placed on a consumer's credit file. Upon seeing a fraud alert display on a consumer's credit file, a business is required to take steps to verify the consumer's identity before extending new credit. If you are a victim of identity theft, you are entitled to an extended fraud alert, which is a fraud alert lasting 7 years. A security freeze does not apply to a person or entity, or its affiliates, or collection agencies acting on behalf of the person or entity, with which you have an existing account that requests information in your credit report for the purposes of reviewing or collecting the account. Reviewing the account includes activities related to account maintenance, monitoring, credit line increases, and account upgrades and enhancements.
·
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.consumerfinance.gov/learnmore.
·
15
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. For information about your federal rights, contact: TYPE OF BUSINESS: CONTACT:
1.a. Banks, savings associations, and credit unions with total assets of over $10 billion and their affiliates
b. Such affiliates that are not banks, savings associations, or credit unions also should list, in addition to the CFPB: a. Consumer Financial Protection Bureau
1700 G Street, N.W.
Washington, DC 20552
b. Federal Trade Commission
Consumer Response Center
600 Pennsylvania Avenue, N.W.
Washington, DC 20580
2. To the extent not included in item 1 above:
a. National banks, federal savings associations, and federal branches and federal agencies of foreign banks
b. State member banks, branches and agencies of foreign banks
(other than federal branches, federal agencies, and Insured State Branches of Foreign Banks), commercial lending companies owned or controlled by foreign banks, and organizations operating under section 25 or 25A of the Federal Reserve Act.
c. Nonmember Insured Banks, Insured State Branches of Foreign Banks, and insured state savings associations d. Federal Credit Unions
a. Office of the Comptroller of the Currency
Customer Assistance Group
1301 McKinney Street, Suite 3450
Houston, TX 77010-9050
b. Federal Reserve Consumer Help Center
P.O. Box 1200
Minneapolis, MN 55480
c. FDIC Consumer Response Center
1100 Walnut Street, Box #11
Kansas City, MO 64106
d. National Credit Union Administration
Office of Consumer Financial Protection (OCFP)
Division of Consumer Compliance Policy and Outreach 1775 Duke Street
Alexandria, VA 22314
3. Air Carriers Asst. General Counsel for Aviation Enforcement &