DISCLOSURE AND AUTHORIZATION
[IMPORTANT -- PLEASE READ CAREFULLY
BEFORE SIGNING AUTHORIZATION]
DISCLOSURE REGARDING BACKGROUND INVESTIGATION
(“the Company”) may obtain information
about you for employment purposes from a third party consumer reporting agency. Thus, you may be the subject of a “consumer report” and/or an “investigative
consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve
personal interviews with sources such as your neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal history,
social security verification, motor vehicle records (“driving records”), verification of your education or employment history, or other background checks. You have
the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer
report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment
is an investigation into your education and/or employment history conducted by CastleBranch, 1845 Sir Tyler Drive, Wilmington, NC 28405, 888-723-4263, or
another outside organization. The scope of this notice and authorization is all-encompassing, however, allowing the Company to obtain from any outside organization
all manner of consumer reports and investigative consumer reports now and throughout the course of your employment to the extent permitted by law. As a result,
you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report.
New York and Maine applicants or employees only:
You have the right to inspect and receive a copy of any investigative consumer report
requested by the Company by contacting the consumer reporting agency identified above directly. You may also contact the Company to request the name, address, and telephone number of the nearest unit of the consumer reporting agency designated to handle inquiries, which the
Company shall provide within 5 days.
New York applicants or employees only:
Upon request, you will be informed whether or not a consumer report was requested by the Company,
and if such report was requested, informed of the name and address of the consumer reporting agency that furnished the report. By signing
below, you also acknowledge receipt of Article 23-A of the New York Correction Law.
Oregon applicants or employees only:
Information describing your rights under federal and Oregon law regarding consumer identity theft
protection, the storage and disposal of your credit information, and remedies available to you should you suspect or find that the Company has
not maintained secured records is available to you upon request.
Washington State applicants or employees only:
You also have the right to request from the consumer reporting agency a written summary of
your rights and remedies under the Washington Fair Credit Reporting Act.
ACKNOWLEDGEMENT AND AUTHORIZATION
I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT
REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of “consumer reports” and/or “investigative
consumer reports” by the Company at any time after receipt of this authorization and throughout my employment, if applicable. To this end, I hereby authorize,
without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service
bureau, employer, or insurance company to furnish any and all background information requested by CastleBranch, 1845 Sir Tyler Drive, Wilmington, NC 28405,
888-723-4263, another outside organization acting on behalf of the Company, and/or the Company itself. I agree that a facsimile (“fax”), electronic or photographic
copy of this Authorization shall be as valid as the original.
New York applicants or employees only:
By signing below, you also acknowledge receipt of Article 23-A of the New York Correction Law
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*This information will be used for background screening purposes only and will not be used as hiring criteria.
[Note: If you do business in Utah, you cannot ask for DOB, driver’s license, or SSN until either a confidential offer of employment or at the time
the background report will be run.]
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For Employer Use Only: Please mark the searches to be conducted.
NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW
( “ t h e
Company”) intends to obtain information about you for employment purposes from a consumer reporting agency. Thus, you can expect to be the subject of “investigative consumer reports” and “consumer credit reports” obtained for employment purposes. Such
reports may include information about your character, general reputation, personal characteristics and mode of living. With respect
to any investigative consumer report from an investigative consumer reporting agency (“ICRA”), you, including but not limited to
obtaining a criminal record report, verifying references, work history, your social security number, your educational achievements,
licensure, and certifications, your driving record, and other information about you, and interviewing people who are knowledgeable
about you. The results of this report may be used as a factor in making employment decisions. The source of any investigative consumer report (as that term is defined under California law) will be CastleBranch, 1845 Sir Tyler Drive, Wilmington, NC 28405,
888-723-4263. The source of any credit report will be CastleBranch, 1845 Sir Tyler Drive, Wilmington, NC 28405, 888-723-
4263. The Company agrees to provide you with a copy of an investigative consumer report when required to do so under California
Under California Civil Code section 1786.22, you are entitled to find out from an ICRA what is in the ICRA’s file on you with proper
identification, as follows:
• In person, by visual inspection of your file during normal business hours and on reasonable notice. You also may request a
copy of the information in person. The ICRA may not charge you more than the actual copying costs for providing you with
a copy of your file.
• A summary of all information contained in the ICRA’s file on you that is required to be provided by the California Civil
Code will be provided to you via telephone, if you have made a written request, with proper identification, for telephone
disclosure, and the toll charge, if any, for the telephone call is prepaid by or charged directly to you.
• By requesting a copy be sent to a specified addressee by certified mail. ICRAs complying with requests for certified mailing
shall not be liable for disclosures to third parties caused by mishandling of mail after such mailings leave the ICRAs.
“Proper Identification” includes documents such as a valid driver’s license, social security account number, military identification
card, and credit cards. Only if you cannot identify yourself with such information may the ICRA require additional information
concerning your employment and personal or family history in order to verify your identify
The ICRA will provide trained personnel to explain any information furnished to you and will provide a written explanation of any
coded information contained in files maintained on you. This written explanation will be provided whenever a file is provided to you
for visual inspection.
You may be accompanied by one other person of your choosing, who must furnish reasonable identification. An ICRA may require
you to furnish a written statement granting permission to the ICRA to discuss your file in such person’s presence.