APPLICANT MUST READ AND SIGN
I certify that I have read and understood all of this employment application . It is agreed and understood that the employer or his agents may investigate my background to ascertain any and all information of concern 10 my employment history, whether same is of record or not, and I release employers and other persons named herein from all liability for any damages on account of furnishing such information. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks which are pertinent to the job. I also understand that if offered a job, it may be conditioned on the results of a physical examination and drug test.
I further certify that I am a genuine applicant for employment and this application is being submitted solely for the purpose of seeking employment with the employer and for no other reason.
It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508. I have been told that this investigation may include and investigative Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living.
I agree to furnish such additional information and complete such examinations as may be required to complete my employment file. I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal.
If hired, I agree to abide by all the rules and policies of the employer.
This certifies that this application was completed by me, and that all entries on it and information in it arc true and complete to the best of my knowledge .
DISCLOSURE AND RELEASE
In connection with my application for employment (including contract for services) with you, I understand that consumer reports, which may contain public record information, may be requested from DAC Services,Tulsa, Oklahoma. These reports may include the following types of information: names and dates of previous employers, reason for termination of employment, work experience , accidents, etc. I further understand that such reports may contain public record information concerning my driving record, workers’ compensation claims, credit, bankruptcy proceedings, criminal records, etc.,from federal, state and other agencies which maintain such records; as well as information from DAC concerning previous driving record requests made by others from such state agencies, and state provided driving records.
I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY DAC SERVICES TO FURNISH THE ABOVE-MENTIONED INFORMATION.
I have the right to make a request to DAC, upon proper identification, 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 recipients of any reports on me, which DAC has previously furnished within the two year period preceding my request. I hereby consent to your obtaining the above information from DAC, and Iagree that such information, which DAC has or obtains, and my employment history with you if I am hired, will be supplied by DAC to other companies, which subscribe to DAC services.
I hereby authorize procurement of consumer report(s) . If hired (or contracted), this authorization ion shall remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my employment (or contract) period.
Pre-Employment Inquiry Release
In connection with, and for the duration of, my employment (including contract for services) with you, I understand that investigative background inquires are to be made on myself including consumer,criminal, driving, and other reports. This information will, in whole or in part, be obtained from California Drug Testing Associates (COTA). 1011 Camino Del Rio South, Suite 200, San Diego, CA 92108 Phone Number: 888-908-2382. These reports will include information as to my character, work habits, performance and experience along with reasons for termination of past employment from previous employers. Further, I understand that you will be requesting information from various federal, state and other agencies which maintain records concerning my past activities relating to my driving, credit, civil and other experiences as well as claims involving me in the files of insurance companies. This release may also be used to obtain worker’s compensation and education records.
I authorize,without reservation, any party or agency contacted by this employer to furnish the above mentioned information.
California, Minnesota and Oklahoma Applicants Only: Please check here to have a copy of your consumer report sent directly to you. Minnesota and Oklahoma applicants receive a copy direct from CDTA California applicants may receive a copy from either the prospective employer or CDTA
Notice to California Applicants
Under Section 1786.22 of the California Civil Code, you have the right to request from COTA, upon proper identification. the nature and substance of all information in its files on you, including the sources of information, and the recipients of any reports on you which COTA has previously furnished within the two-year period preceding your request. You may view the file maintained on you by COTA during normal business hours. You may also obtain a copy of this file upon submitting proper identification and paying the costs of duplication services. Upon making a written request, you may receive a summary report via telephone