Please fill out the information below and continue to read and sign the forms until you reach the submit button. Don't forget to hit "Submit" to send the completed form to Journeys' HR department.
I certify that all elements of the personal data I have provided are true, accurate and complete.
Consumer Report (CR) Disclosure
DISCLOSURE REGARDING BACKGROUND INVESTIGATION
JOURNEYS IN COMMUNITY LIVING ("The Company") may obtain information about you from a third-party consumer reporting agency for employment purposes. Thus, you may be the subject of a "consumer report" which may include information about your character, general reputation, personal characteristics, and/or mode of living. These reports may contain information regarding your 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, to request whether a consumer report has been run about you and to request a copy of your report. These searches will be conducted by JD Palatine, LLC dba JDP. 855-940-3232, 10675 Perry Hwy #607. Wexford, PA 15090, jdp.com. To the extent permitted by law, the Company may obtain consumer reports from any outside organization throughout the course of your employment.
[End of DISCLOSURE REGARDING BACKGROUND INVESTIGATION]
Investigative Consumer Report (ICR) Disclosure
DISCLOSURE FOR INVESTIGATIVECONSUMER REPORT
JOURNEYS IN COMMUNITY LIVING, the "Company," may request an investigative consumer report about you from a third-party consumer reporting agency, in connection with your employment or application for employment. An "investigative consumer report" is a background report that includes information from personal interviews (except in California, where that term includes background reports with or without information obtained from personal interviews). The most common form of an investigative consumer report in connection with your employment is a reference check through personal interviews with sources such as your former employers and associates, and other information sources. The investigative consumer report may contain information concerning your character, general reputation, personal characteristics, mode of living, or income verification. You may request more information about the nature and scope of an investigative consumer report, if any, by contacting the Company.
If adverse action is taken resulting from information obtained, in whole or in part, from an Investigative Consumer Report from a consumer reporting agency, you will have the option to receive a copy of the report from JD Palatine, LLC dba JDP. JD Palatine, LLC dba JDP can be contacted at 10675 Perry Hwy #607, Wexford, PA 15090 or by phone/fax at 855-940-3232 or fax 724-799-8460.
[End of DISCLOSURE FOR INVESTIGATIVE CONSUMER REPORT]
ACKNOWLEDGMENT AND AUTHORIZATION
ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK
I acknowledge receipt of the separate documents entitled DISCLOSURE REGARDING BACKGROUND INVESTIGATION, A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and the DISCLOSURE FOR INVESTIGATIVE CONSUMER REPORT and certify that have read and understand 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 JD Palatine, LLC dba JDP, 855-940-3232. 10675 Perry Hwy #607. Wexford, PA 15090, jp.com and/or Company itself. I agree that a facsimile ("fax"), electronic or photographic copy of this Authorization shall be as valid as the original.
I understand that by signing below, that by doing so:
[End of ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK]
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.
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/leammore 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
You may limit "prescreened" offers of eredit 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 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.consumerlinance.gov/leammore.
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 total assets of more than $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 Bureau1700 G. Street, N.W.Washington, DC 20552
b. Federal Trade CommissionConsumer Response Center600 Pennsylvania Avenue, N.W.Washington, DC 20580(877) 382-4357
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 Group130 I McKinney Street, Suite 3450 Houston, TX 770 I 0-9050
b. Federal Reserve Consumer Help Center
c. FDIC Consumer Response CenterI 100 Walnut Street, Box #11Kansas City, MO 64106
d. National Credit Union AdministrationOffice of Consumer Financial Protection (OCFP) Division of Consumer Compliance Policy and Outreach 1775 Duke StreetAlexandria, VA 223 14
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