New Contractor Screening

Position Applying For*

Name*

First NameLast Name

DOB*

MonthDayYear

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Mobile*

Area CodePhone Number

Email*

DO NOT USE A WORK OR SCHOOL EMAIL ADDRESS!! PERSONAL EMAIL ONLY!!!

Resume*

Browse Files

Emergency Contact*

Are you legally eligible to conduct business in the United States?*

YesNo

Have you ever been convicted of a felony or misdemeanor*

YesNo

Valid Drivers License*

YesNo

Access to a vehicle*

YesNo

Available to start*

Date

Hourly rate desired*

Availability*

	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
6 PM

How did you hear about us?*

if reffered, please enter the name of the person who reffered you

The Facts set forth in this application and any supplemental information is true and complete to the best of my knowledge. I understand that falsified statement on this application shall be considered sufficient cause for immediate discharge. I hereby authorize investigation of all statements contained herein and employees listed above to give you any and all information concerning my employment, and any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same understand that I am required to abide by all rules and regulations of the company. *

Section 1: Disclosure

Centered Solutions may request background information about you from a consumer reporting agency in connection with your employment application and for employment purposes. The report ordered is defined by the Fair Credit Reporting Act (FCRA) as a Consumer Report, and all inquiries are limited to information that affects job performance and the workplace. It is conducted in accordance with applicable federal and state laws including the FCRA. The screening will be conducted by an outside agency:
Goodhire, LLC. Address: P.O. Box 391403 Omaha, NE P: 1-888-906-7351 E: support@goodhire.com

As a result, Goodhire may obtain a consumer report on you as an applicant for during employment. The consumer report is a compilation of information that might affect your employability. the scope of the report may include information concerning your driving record, civil and criminal court records, credit, drug screening results, workers compensation record, education, credentials, identity, past addresses, social security number, previous employment and personal references. Should an employee or rely on consumer reports for the adverse action, the FCRA mandates you be provided with a copy of the consumer report and a summary of your rights. An adverse action is defined as a “denial of employment or any other decision for employment purposes that adversely affect any current or prospective employee”.

Section II: Authorization and Release

I have carefully read and understand this Candidate Disclosure, Authorization and Consent for the Procurement of consumer report form and attached summary of rights under the Fair Credit Reporting Act. By my signature below, I can send to the release of consumer reports an investigative consumer report prepared by a consumer reporting agency: Goodhire, LLC, to the company and to the company and its designated representatives and agents.

By my signature below, I authorized the company to share the contents of this consumer report for investigative consumer report with its partners and clients in an effort to please me into an appointment independent contractor relationship with those partners. I understand that if the company hires me my consent will apply and the company may have teamed reports throughout my employment. I also understand the information contained in my job application or otherwise disclosed by me before or during my employment, if any, may be used for the purpose of obtaining consumer reports and/or investigative consumer reports.

By my signature below I authorized law enforcement agencies learning institutions (including public and private schools and universities), information service bureaus, Credit bureaus, Record/data repositories, courts (federal, state, and local), on me that is requested by consumer reporting agency.

By my signature below I certify the information I provided on this form is true and correct and will be valid for any reports then maybe requested by or on behalf of the Company.

I authorize Goodhire and its agents to contact my current employee if necessary to verify my current employment status after the following date:

Signature*

Applicant Information

Candidate Disclosure, Authorization & Consent to The Procurement of Consumer Reports