Complete the following for your employee file (Please Print):
Notify Timekeeping and Payroll of new employee;Delivercompleted packet to HR
Employee's Withholding Certificate
Department of the Treasury Internal Revenue Service
Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Give Form W-4 to your employer. Your withholding is subject to review by the IRS.
Does your name match the name on your social security card? If not, to ensure you get credit for your earnings, contact SSA at 800-772-1213 or go to www.ssa.gov.
Complete Steps 2-4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can claim exemption from withholding, when to use the estimator at www.irs.gov/W4App, and privacy.
TIP: To be accurate, submit a 2022 Form W-4 for all other jobs. If you (or your spouse) have self-employment income, including as an independent contractor, use the estimator. Complete Steps3-4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3-4(b) on the Form W-4 for the highest paying job
If your total income will be $200,000 or less ($400,000 or less if married filing jointly):
Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.
Illinois Withholding Allowance Worksheet
Use this worksheet as a guide to figure your total withholding allowances you may enter on your Form IL-W-4. Complete Step 1. Complete Step 2 if you (or your spouse) are age 65 or older or legally blind, or you wrote an amount on Line 4 of the Deductions Worksheet for federal Form W-4.
If you have more than one job or your spouse works, your withholding usually will be more accurate if you claim all of your allowances on the Form IL-W-4 for the highest-paying job and claim zero on all of your other IL-W-4 forms. You may reduce the number of allowances or request that your employer withhold an additional amount from your pay, which may help avoid having too little tax withheld.
Step 1: Figure your basic personal allowances (including allowances for dependents)
Step 2: Figure your additional allowances
Form IL-W-4 below. This number may not exceed the amount on Line 3 above, however you can claim as few as zero. Entering lower numbers here will result in more money being withheld(deducted) from your pay.
Cut here and give the certificate to your employer. Keep the top portion for your records.
Illinois Department of Revenue
IL-W-4 Employee's Illinois Withholding Allowance Certificate
Printed by the authority of the State of Illinois PO Number: 2200208 500 copies
This form is authorized under the Illinois Income Tax Act. Disclosure of this information is required. Failure to provide information may result in this form not being processed and may result in a penalty.
Employer: Keep this certificate with your records. If you have referred the employee's federal certificate to the IRS and the IRS has notified you to disregard it, you may also be required to disregard this certificate. Even if you are not required to refer the employee's federal certificateto the IRS, you still may be required to refer this certificate to the Illinois Department of Revenue for inspection. See Illinois Income Tax Regulations 86 III. Adm. Code 100.7110.
Employment Eligibility Verification Department of Homeland Security
U.S. Citizenship and Immigration Services
START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form. ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.
Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 nolater than the first day of employment, but not before accepting a job offer
Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.
QR Code Section 1 Do Not Write In This Space
(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1
I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.
I hereby voluntarily authorize SENCO Construction Inc to direct deposit my pay check into my account(s) at the financial institution(s) named below.
Further, I agree not to hold SENCO Construction Inc responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account.
This agreement will remain in effect until SENCO Construction Inc receives a written notice of cancellation from me or my financial institution, or until I submit a new direct deposit form to the Payroll Department.
Anytown Bank Anytown, MI 48888
The purpose of this indoctrination is to inform new employees of the basic safety rules and regulations they must follow. Employees must understand what safety equipment they will be required to use, and how to utilize it properly. Specialized training and equipment may also be required, depending on the scope of the work the employee will be performing.
In addition to the basic safety rules and regulations, there are additional policies specific to SENCO Construction Inc. that must be read and understood prior to beginning work with the company. this includes teh SENCO Construction Inc. "Disciplinary Policy" and the SENCO Construction Inc. "Anti-Harassment Policy."
You must first read the contents of this "New Employee Indoctrination" packet. After reading and understanding the contents, you will be required to provide your signature and the date which you signed. Failure to provide your signature will result in ineligibility to work for SENCO Construction Inc. Employee questions are encouraged in order to provide new employees with as much useful information as possible. It is your responsibility to report any unsafe acts or conditions to your supervisor or the safety department.
You may NOT have any of the following items in your possession or in your vehicle while it is on SENCO or Marathon property:
Personal Protective Equipment
The following personal protective equipment (PPE) will be required while performing work for SENCO:
As an employee, you have the right to know what chemicals and hazards exist in your work area. Youshould be familiar with the HAZCOM standard. A list of all hazardous chemicals and SDSs are available to you at your request. A copy of the SENCO Construction Inc. Hazard Communications Program is available to you at any time. You must be aware of the physical and health hazards associated with hazardous chemicals in your work environment, and the measures and PPE available to you to protect yourself from these hazards. You must also be able to read and understand an SDS. Employees must also have an understanding of container and hazardous chemical labeling.
SENCO Construction, Inc. has developed this disciplinary policy as a means of addressing employee safety infractions. Communication between Management, Supervision, Safety, and all employees is critical to ensure that employees understand the safety policies and procedures they are expected to observe. When supervision or safety must address an employee's infraction, the following guidelines will be used to ensure effective communication has taken place with the affected employee(s)
If it is determined that the employee has intentionally violated a known safety policy or procedure, or has performed an act that could potentially cause harm to himself, herself, or another employee, that employee will be subject to the following disciplinary action:
** Willful safety violations in which an employee demonstrates disregard for the safety of any person, including himself/herself, or other employees, which could result in personal injury or result in property damage, will not be tolerated, and may result in immediate termination from work.
The following will be regarded as safety infractions, and will be treated as such:
It shall be the responsibility of SENCO Management, Supervision and Safety Department to ensure that all employees are observing company safety policies and program guidelines. Also, SENCO Management, Supervision and Safety Department must perform physical inspections of the work area(s Any employee lack of commitment to safety, or any safety violations observed, will be regarded as a serious violation, and will result in employee disciplinary action.
Management and Supervision must be held to the same accountability as all other employees. Any SENCO employee has the right and responsibility to inform Management or Supervisor personnel of any safety violations that they (Management or Supervisors) may be committing. All employees must practice safe work procedures in order to achieve our safety goals.
Equal Employment Oppurtunity
SENCO Construction, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
Everyone deserves to work in an environment that is pleasant, professional, and free of intimidation or hostility - be it verbal, physical, or visual. Any form of unwelcomed behavior - whether harassment or not - is unacceptable at SENCO.
Sexual harassment is defined as unwelcome sexual advances, request for sexual favors, and other verbal or physical conduct of a sexual nature when this conduct explicitly or implicitly affects an individual's employment, unreasonably interferes with an individual's work performance, or creates an intimidating, hostile, or offensive work environment.
Harassment isn't always sexual in nature, and it's not always direct. It can include offensive language, statements, jokes, cartoons, pictures, signs, posters, emails, pranks, intimidation, physical contact, violence, threatening phone calls, or derogatory remarks - even if they are not directed to the targeted individual. If it makes you feel uncomfortable, it should be addressed. SENCO also prohibits any retaliation against an employee who has discussed or made a harassment complaint.
If you or a co-worker have been the subject of any form of harassment, immediately report the conduct to your supervisor or to Management. Once the company is informed, we will take prompt and appropriate action to investigate the incident. No retaliatory action will be taken against you if your report is made in good faith. A worker determined to exhibit behavior contributing to harassment of anyone in the workplace will be subject to disciplinary action, including termination, with or without notice.
SENCO Construction complies fully with all applicable federal, state and local laws to include the Concealed Carry Act. Firearms of any type are strictly prohibited within company premises at all times. Company premises includes the SENCO Main Office, Safety Annex, Fabrication Shop, Maintenance Shop and all parking lots excluding the gravel lot south of the SENCO Training Center. Company premises also include anywhere that company business is conducted, such as customer locations, vendor/associate locations, trade shows, restaurants or any venue visited for the purpose of business.
Regardless of whether an employee possesses a concealed carry permit or is allowed by law to possess a firearm, firearms are prohibited on all company premises, except the south parking lot.
Please note: Firearms and weapons, including those used for hunting or fishing, are only permitted inside of personal vehicles located in SENCO's South parking lot and only with the approval of company Management.
SENCO reserves the right to perform searches of employees, customers, vendors, and vehicles entering, leaving, or parking on SENCO property for illegal drugs, paraphernalia, weapons, and stolen property. SENCO also reserves the right to search any employee's office desk, files, lockers, computers, and office files on our premises. These items are the property of SENCO. Inspections may be conducted at anytime at the discretion of SENCO.
Compliance with Marathon Petroleum Policies
SENCO employees working for SENCO on Marathon Petroleum Company premises are subject to all MPC policies and SPs. These SPs are available to you, from MPC or SENCO, should you wish to review them at any time. Some policies of interest may include, but are not limited to:
There is enhanced focus on Life Critical Safety Rules including:
Violations of Life Critical Safety Rules may result in permanent removal from MPC and/or SENCO.
Additional details regarding MPC Policies will be provided during Safety Orientation.
It is the policy of SENCO Construction Inc. that all employees are employed at the will of the company. Employees may resign from the company at any time for any reason and may be terminated by the company at any time for any reason, with or without notice.
Work and Pay Schedule
You will be informed of your work schedule when you report to work for SENCO Construction Inc. The pay period begins on Monday and concludes on Sunday. You will receive your check the following Wednesday for the previous week's work.
All employee grievances should be reported to SENCO Supervision. Employee complaints will be addressed by management in a confidential manner. Reporting grievances will not result in any form of retaliation.
You will be required to attend a weekly safety meeting conducted by the SENCO Safety Department. In addition to the weekly meeting, you are expected to participate in a daily tool-box meeting with your immediate work group as well as SENCO Construction's daily stretching program. This will be conducted by the job foreman at the beginning of each shift.
By signing below, you acknowledge that you have read and understand all policies and procedures provided to you in the SENCO Construction Inc. New Employee Indoctrination, and that failure to comply with these policies will result in disciplinary action or possible termination.
I understand that access to information obtained under this policy is limited to those who have a legitimate need to know in compliance with relevant laws and management policies. SENCO may use information obtained under this Policy to support, explain, or defend any employment decision or action taken with regard to that employee including, but not limited, defending against any claim for unemployment benefits by the employee.
I understand that my failure to honor all the terms of this certificate is ground for immediate termination of my employment.
The statements contained in the SENCO CONSTRUCTION INC. DRUG-FREE WORKPLACE POLICY are intended to serve as general information concerning SENCO CONSTRUCTION INC. and its existing policies, procedures, and practices.
Nothing contained in the SENCO CONSTRUCTION INC. DRUG-FREE WORKPLACE POLICY is intended to create, nor shall be construed as creating, an expressed or implied contract of employment or guarantee of employment for the definite or indefinite terms.
From time to time SENCO CONTRUCTION INC. may need to clarify, amend, and/or supplement the information contained in the Drug and Alcohol Policy. The company will inform me of these changes.
I understand that I will not be compensated for any time, including show up time, for any time awaiting laboratory drug testing results following a positive or invalid instant test that results in a confirmed positive test by the MRO.
Printed Name Witness Signature Please list Authorized Substances prescribed by your physician:
The following grading matrix criteria represents a selection of specific conviction types for federal, felony and misdemeanor convictions. Each of the two following lists will be used to assign numeric values to each “graded” criminal report. The “graded” matrix criteria will be applied against the county/parish, federal and Patriot Act searches for the Graded Package 2.0. This includes of all qualifying federal, misdemeanors and felony conviction types.
The record is a conviction beyond seven years (based upon the disposition date).
The record is a non-conviction (except for adjudication withheld, deferred adjudication or any other disposition where an individual must complete some criteria before a final disposition is determined).
Grade will be sent as a "CLEAR."
The charge type is Misdemeanor and is NOT one of the following Misdemeanors where the disposition is a conviction, pending, or adjudication withheld, deferred adjudication or any other disposition where an individual must complete some criteria before a final disposition is determined within 7 years based upon the disposition date.
The charge type is one of the following Misdemeanors where the disposition is a conviction, pending, or adjudication withheld, deferred adjudication or any other disposition where an individual must complete some criteria before a final disposition is determined within 7 years based upon the disposition date.
The charge type is Federal or Felony and is NOT one of the following Federal or Felonies where the disposition is a conviction, pending, or adjudication withheld, deferred adjudication or any other disposition where an individual must complete some criteria before a final disposition is determined within 7 years based upon the disposition date.
Grade will be sent as a "Hit- 03"
The charge type is Federal or Felony and is NOT one of the following Federal or Felonies AND the charge type is one of the Misdemeanors listed below where the disposition is a conviction, pending, or adjudication withheld, deferred adjudication or any other disposition where an individual must complete some criteria before a final disposition is determined within 7 years based upon the disposition date.
Grade will be sent as a "Hit- 04"
The charge type is one of the following Federal or Felonies where the disposition is a conviction, pending, or adjudication withheld, deferred adjudication or any other disposition where an individual must complete some criteria before a final disposition is determined within 7 years based upon the disposition date.
The charge type is one of the following Federal or Felonies AND the charge type is one of the following Misdemeanors where the disposition is a conviction, pending, or adjudication withheld, deferred adjudication or any other disposition where an individual must complete some criteria before a final disposition is determined within 7 years based upon the disposition date.
Leave the record information "as is."
Reporting if the applicant is subject to various economic-sanctioned programs administered by the Office of Foreign Assets Control, such as specially designated nationals, terrorists, narcotics traffickers, and blocked persons and vessels.
COUNTY CRIMINAL MISDEMEANOR CONVICTIONS
The following list represents a selected list of misdemeanor conviction types to be used for the purposes of assigning a numeric “graded” value. The Qualified Vendor will review all qualifying misdemeanor conviction types and apply the appropriate “graded” value based on the specific conviction type.
AssaultBatteryBodily InjuryCruelty to a JuvenileDeadly ConductDisorderly ConductDisorderly PersonEscapeHarassmentResisting arrestResisting Public OfficerRobberyTerrorist ThreatsThrowing a deadly missileViolation of restraining orderWeapon
COUNTY CRIMINAL FELONY or FEDERAL CONVICTIONS
A crime involving a severe transportation security incident (i.e. Security incident involving a significant loss of life, environmental damage, transportation system disruption, or economic disruption in a particular areaAiding others in terrorismAircraft piracy outside the special aircraft jurisdiction of the United States, 49 U.S.C. 46502(b)* aircraft piracy, 49 U.S.C. 46502*ArsonAssault (including aggravated and or sexual)BriberyBurglary (breaking and entering)
CarjackingCarrying a weapon or explosive aboard aircraft, 49 U.S.C. 46505*
Commission of certain crimes aboard aircraft in flight, 49 U.S.C. 46506*Computer crimes (hacking, fraud, damage to property)Conveying false information and threats, 49. U.S.C. 46507*Credit card fraudCriminal anarchyDenied or removed under the Immigration And Nationality Act (8 U.S.C. 1182 Et Seq)*Destruction of an aircraft or aircraft facility, 18 U.S.C. 32*Drug offensesEmbezzlementEspionageExplosive offenses (devices, fake explosive devices, incendiary devices, dangerous articles, importation, manufacture, distribution, storage)ExtortionFalse imprisonment - armed or hostage takingFalse personating (peace office, public official)Forgery and counterfeitingFraud (including dishonesty and misrepresentation)Homicide / murder / manslaughter / including solicitation to murder (excluding negligent manslaughter)Identify theftImmigration violationsImproper transportation of a hazardous material, 49 U.S.C. 46312*Interference with air navigation, 49 U.S.C. 46308*Interference with flight crew members or flight attendants, 49 U.S.C. 46504*KidnappingLighting violations involving transporting controlled substances, 49 U.S.C. 46315*Misprision of treasonMonetary instrument abusePerjury and false swearingPurse snatchingRacketeering and RICO violationsRapeRobberySeditionSex crimesSmugglingTax evasionTerrorismTheft-larceny (including felony shoplifting)TreasonUnlawful entry into an aircraft or airport area that serves air carriers or foreign air carriers contrary to established security requirements, 49 U.S.C. 46314*Weapons (any offense-carrying a concealed weapon, weapon on premises, illegal use, manufacture, store, sell,distribute, discharge, etc.)Traffic offenses i.e., traffic homicide, hit and run (excluding dwi/dui convictions) *United States Code is offered as a reference to the nature of the crime. Similar state laws are also considered disqualifying.
Para información en español, 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 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:
o a person has taken adverse action against you because of information in your credit report;
o you are the victim of identity theft and place a fraud alert in your file;
o your file contains inaccurate information as a result of fraud;
o you are on public assistance;
o 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 (1-888-567-8688).
· 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 collectionagencies acting on behalf of the person or entity, with which you have an existingaccount that requests information in your credit report for the purposes of reviewing or collecting the account. Reviewing the account includes activities related to accountmaintenance, 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.
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:
1.a. Banks, savings associations, and credit unions with totalassets of over $10 billion and their affiliates
b. Such affiliates that are not banks, savings associations, orcredit unions also should list, in addition to the CFB:
Consumer Financial Protection Bureau 1700 G Street, N.W. Washington, DC 20552
b. Federal Trade CommissionConsumer Response Center600 Pennsylvania Avenue, N.W.Washington, DC 20580(877) 382-4357
SENCO CONSTRUCTION, INC
DRIVER'S PRIVACY PROTECTION ACT
DISCLOSURE AND EXPRESS CONSENT
In connection with your application for employment, application to serve as a contractor, or in connection with your continued employment or continued service as a contractor with SENCO Construction, Inc. (“SENCO”), you understand that SENCO may request information regarding you and your motor vehicle record from the state department of motor vehicles, or similar state agency (e.g. Illinois Secretary of State), which issued you your current drivers license. You understand that your motor vehicle record may include information that identifies you, including your photograph, social security number, driver identification number, name, address, telephone number, medical or disability information, and driving record (“Motor Vehicle Record”). You understand that SENCO has contracted with S2Verify of Roswell (Atlanta) Georgia to obtain your Motor Vehicle Record.
By signing below you hereby authorize SENCO directly, and through S2Verify, to obtain your Motor Vehicle Record from the state agency which issued you your current drivers license. You hereby authorize and request, without any reservation, that the state agency which issued you your current drivers license to furnish to SENCO and S2Verify your Motor Vehicle Record. You understand and agree that SENCO may use your Motor Vehicle Record for employment purposes.
AUTHORIZATION FOR SAFETY COUNCIL OF TEXAS CITY
TO PROCESS MY SOCIAL SECURITY NUMBER FOR VERIFICATION
I hereby acknowledge and agree that the Safety Council of Texas City (herein referred to as SCTC) has a legitimate business need to verify my identity before I can be issued a Council badge which indicates, by virtue of its existence, that my identity has been verified. I understand that by providing authorization to SCTC and partner consumer reporting agencies, to process a verification of my Social Security Number, I shall not be issued a badge from SCTC if the verification process fails to identify me as the proper holder of the Social Security Number I submit below.
I authorize and instruct SCTC and partner consumer reporting agencies, to verify my identity through consumer reports and social security number information and I am providing this as my written instruction and authorization to SCTC and partner consumer reporting agencies to verify my identity through consumer reports and social security number information. I understand that I have the right to request of partner consumer reporting agencies, upon proper identification and the payment of any legally permissible fees, for the information in its files on me at the time of the request.
By my signature at the bottom of this form, I authorize my employer to submit this form on my behalf to the Safety Council so that my verification can proceed as if I was at the Safety Council signing this authorization.