• CRIMSHIELD

    CRIMSHIELD

  • FEDERAL REQUIREMENT: SEPARATE, SINGLE-PAGE, WRITTEN DISCLOSURE TO CONSUMER AND AUTHORIZATION BY CONSUMER FOR PROCUREMENT OF INVESTIGATIVE CONSUMER REPORT INFORMATION

  • THROUGH A CREDIT REPORTING AGENCY

  • 1.CLEAR, ACCURATE AND CONSPICUOUS DISCLOSURE pursuant to the Federal Credit Reporting Act 15 U.S.C. Section 604 (b2Ai):

    TO THE CONSUMER: I am a consumer and understand that this document represents formal notice to me that my employer shall obtain investigative consumer reports (background investigation information) for security purposes and/or employment purposes through CrimShield, Inc., a credit reporting agency.

    2.AUTHORIZATION pursuant to the Federal Credit Reporting Act 15 U.S.C. Section 604 (b2Aii):

    Now, and at any time while I am in the employ of my employer, I authorize CrimShield, Inc., and its agents, to obtain any information they request to complete a background investigation including, but not limited to, character; general reputation; history of payments; driving record; drug screenings; credit bureau reports from any credit reporting agency; workman comp claims; social security number, addresses and date of birth verifications; judgments; criminal history; public records; social records; private records; evictions and any and all information about me that CrimShield may discover. I authorize CrimShield, Inc. to release the results of my background investigation (my investigative consumer report) to my employer; to any company where I may transfer after I sign a transfer form, and; to any person, company or entity with whom my employer(s) contracts or associates in the performance of demonstrations, sales, marketing, groundwork, installation, service for or to a customer, or for the delivery of any other service or product.

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  • CRIMSHIELD

  • SEPARATE AND ADDITIONAL DISCLOSURES, AUTHORIZATIONS, UNDERSTANDINGS AND AGREEMENTS WITH CONSUMER OR APPLICANT

  • I request CrimShield, Inc., (hereinafter referred to as "CRIM") to perform a security clearance background investigation on me (now, and if for employment purposes, at any time while I am in the employ of my employer), which investigation(s) may include, but not limited to, information about identity, criminal history, social media, motor vehicle/driving record, character, reputation, social security, birth, immigration status, personal description, credit worthiness and drug screening research. I understand that I must pass the applicable Security Clearance criteria in order to receive a Security Clearance Card. I understand that CRIM and CRIM's agents will be performing the investigation and may be issuing a Security Clearance Card based on CRIM's criteria; the criteria of my employer, or; the criteria of my employer's client(s) for security purposes to determine whether I qualify to have access to my employer's clients' customers or facilities. I authorize and direct any and all governmental agencies, private entities, companies and/or individuals to release any and all information relating to me to CRIM or CRIM's agents. | understand that CRIM may need a copy of my social security card, driver license or other personal documentation to complete its investigation and I agree to fully cooperate with CRIM to assist CRIM to complete my investigation. I understand and agree that the CrimShield "Security Clearance Card" Certification belongs solely to CRIM and that CRIM has the absolute right to not issue a CrimShield Security Clearance Card to me at CRIM's sole discretion. I understand that the CrimShield Security Clearance Card is the property of CRIM. I also understand that if I pass the applicable criteria that CRIM may grant me an "at will", revocable license to wear and use the CrimShield Security Clearance Card. If I am granted a revocable license I agree that if my CrimShield Security Clearance Card is terminated for any reason that I must and will immediately return the CrimShield Security Clearance Card to my former employer if I received CrimShield Security Clearance Card for employment purposes or to CRIM if I received it only for Security Purposes. I understand that if I fail to immediately return the CrimShield Security Clearance Card upon termination as indicated above that failure to do so will be considered felony theft as the value of the CrimShield Security Clearance Card well exceeds one thousand dollars ($1,000.00) and that prosecution will be initiated. Lastly,I understand that no further notice is required before theft charges can be pursued. I understand and agree that the CrimShield Security Clearance Card incorporates the name of CrimShield, Inc. and is the sole property of CrimShield, Inc. I understand that CRIM has the right to protect its good name and reputation, regardless of any other factors. I further understand that CRIM does not discriminate on the basis of race, color, National origin, familial status, military service, religion or creed, sexual orientation, age, gender, or disabilities. I agree, to the extent not prohibited by any applicable law, to have any claim, dispute or controversy arising out of any investigation by CRIM be decided by arbitration and I waive any right to a jury trial or trial by a judge. I also waive the right to appeal. I agree that Mesa, Arizona is the exclusive venue and jurisdiction for arbitration. I also irrevocably waive any right to join claims with those of others in any form of class action or similar procedure; and any claim thatI may bring shall only be asserted individually. I agree that any cause of action must be filed within one calendar year from the time any claim or cause of action arises, or forever be barred. Notwithstanding anything I agree to in this paragraph, if there is any clause in the Federal Fair Credit Reporting Act, in the applicable State Fair Credit Reporting Act, or in any other applicable law, that prohibits such an agreement or any provision of this paragraph, then that applicable act or law shall govern any prohibited issue in this paragraph and nothing in this paragraph shall viewed as or considered a violation of any provision of any Fair Credit Reporting Act or any other law. CRIM will only reveal as much of my personal information as needed to obtain information requested and authorized for release by me for its investigation, and CRIM will only reveal such information and the results of my investigation internally, on a "need to know" basis. Furthermore, I direct CRIM to determine if I qualify for a CrimShield Security Clearance Card based on the applicable criteria and I direct CRIM to share the analysis and results of my investigation with my employer and with any person, company or entity with whom my employer may contract or associate with regarding my services in performing demonstrations, sales, marketing, groundwork, installation or service. Also, I agree that CRIM may share my information and report with any police agency or court, if so requested by the same. CRIM shall not sell any information about me. Page 1

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  • CRIMSHIELD

  • CRIM does not maintain an actively updated file on any individual who has had a background investigation performed. Each investigation is conducted at the time it is ordered and only the results of that investigation stored.I understand that I am entitled to a copy of the background investigation report by requesting a copy in writing to: CrimShield, Inc. P.O. Box 5960, Mesa AZ. 85211. I acknowledge receipt of a written summary of my rights pursuant to the FCRA 15 U.S.C 1681 relating to credit reporting information. I certify and warrant that all the information contained in this application is true and correct and that my CrimShield Security Clearance Card may be terminated for any false, misleading, omitted or fraudulent information provided by me to my employer, to CRIM, to any entity for whom I seek a security clearance; or for any reason deemed appropriate by CRIM, my employer or my employer's client(s Drug Screening Policies, when applicable: I understand that if a drug screen is required for my employer or for my employer's client(s) for security purposes for me to have access to my employer's clients' customers or facilities and I fail the drug screen, or have previously failed any drug screen for one year prior to the date of this authorization, I understand that I am prohibited from having access to my client's clients' customers or facilities for one year from the date of any failed drug screen. Furthermore, I understand that I shall not be eligible for a CrimShield Security Clearance Card during that year period. A drug screen failure includes, but is not limited to: The specimen was positive for prohibited drugs; The specimen provided to the lab is outside of the temperature parameters for the lab; The applicant fails to produce a specimen after signing in at the lab; The applicant signs in, but fails to provide a testable specimen before leaving the lab, or; If there is any indication of tampering or fraud regarding the specimen or the applicant.

    The Following Information is REQUIRED:

  • (Used for identification purpose only) S.S. #

  • I authorize CrimShield to investigate my background and attest that the personal information I have provided above is current and accurate. Any falsified information may result in a CrimShield Certification being withheld.

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  • IF FOR EMPLOYMENT PURPOSES: For CA, MN, OK Residents Only: Please provide me with a copy of my background report: Yes: [ No: [] For CA residents: Under section 1762.22 of the California Civil Code, you may view the report processed by CrimShield, Inc. You may obtain a copy of your report by sending your request in writing to the address above. If you have questions about your report, contact our customer service representatives at 1-888-422-2547. Page 2

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  • CRIMSHIELD

  • Applicants Copy

  • NOTICE OF CONSUMER RIGHTS UNDER THE FAIR CREDIT REPORTING ACT

  • A Summary of Your Rights under the Fair Credit Reporting Act The Fair Credit Reporting Act (FCRA) is designed to promote accuracy, fairness, and privacy of information in the files of every "consumer reporting agency" (CRA Most CRAs are credit bureaus that gather and sell information about you -- such as where you work and live, if you pay your bills on time, and whether you've been sued, arrested, or filed for bankruptcy -- to creditors, employers, and other businesses. The FCRA gives you specific rights in dealing with CRAs, and requires them to provide you with a summary of these rights as listed below. You can find the complete text of the FCRA, 15 U.S.C. 1681 et seq., at the Federal Trade Commission's web site (http://www.ftc.gov You must be told if information in your file has been used against you. Anyone who uses information from a CRA to take action against you -- such as denying an application for credit, insurance, or employment -- must give you the name, address, and phone number of the CRA that provided the report. You can find out what is in your file. A CRA must give you all the information in your file, and a list of everyone who has requested it recently. However, you are not entitled to a "risk score" or a "credit score" that is based on information in your file. There is no charge for the report if your application was denied because of information supplied by the CRA, and if you request the report within 60 days of receiving the denial notice. You are also entitled to one free report a year if you certify that (1) you are unemployed and plan to seek employment within 60 days, (2) you are on welfare, or (3) your report is inaccurate due to fraud. Otherwise, a CRA may charge you a fee of up to eight dollars. You can dispute inaccurate information with the CRA. If you tell a CRA that your file contains inaccurate information, the CRA must reinvestigate the items (usually within 30 days) unless your dispute is frivolous. The CRA must pass along to its source all relevant information you provided. The CRA also must supply you with written results of the investigation and a copy of your report, if it has changed. If an item is altered or deleted because you dispute it, the CRA cannot place it back in your file unless the source of the information verifies its accuracy and completeness, and the CRA provides you a written notice that includes the name, address and phone number of the source. Inaccurate information must be deleted. A CRA must remove inaccurate information from its files, usually within 30 days after you dispute its accuracy. The largest credit bureaus must notify other national CRAs if items are altered or deleted. However, the CRA is not required to remove data from your file that is accurate unless it is outdated or cannot be verified. You can dispute inaccurate items with the source of the information. If you tell anyone -- such as a creditor who reports to a CRA -- that you dispute an item, they may not then report the information to a CRA without including a notice of your dispute. In addition, once you've notified the source of the error in writing, they may not continue to report it if it is in fact an error. Outdated information may not be reported. In most cases, a CRA may not report negative information that is more than seven years old; ten years for bankruptcies. Access to your file is limited. A CRA may provide information about you only to those who have a need recognized by the FCRA -- usually to consider an application you have submitted to a creditor, insurer, employer, landlord, or other business.

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  • CRIMSHIELD

  • Your consent is required for reports that are provided to employers or that contain medical information. CRA may not report to your employer, or prospective employer, about you without your written consent. A CRA may not divulge medical information about you without your permission. You can stop a CRA from including you on lists for unsolicited credit and insurance offers. Creditors and insurers may use file information as the basis for sending you unsolicited offers of credit or insurance. Such offers must include a toll-free number for you to call and tell the CRA if you want your name and address excluded from future lists or offers. If you notify the CRA through the toll-free number, it must keep you off the lists for two years. If you request and complete the CRA form provided for this purpose, you can have your name and address removed indefinitely. You may seek damages from violators. You may sue a CRA or other party in state or federal court for violations of the FCRA. If you win, the defendant may have to pay damages and reimburse you for attorney fees. If you lose and the court specifically finds you sued in bad faith, you or your attorney may have to pay the defendant's fees. You may have additional rights under state law. You may wish to contact a state or local consumer protection agency or a state attorney general to learn those rights. If you have questions or believe your file contains errors, call our toll-free number. The FCRA gives several different federal agencies authority to enforce the FCRA:

  • FOR QUESTIONS OR CONCERNS REGARDING:

  • CRAs, creditors and others not listed below National banks, federal branches/agencies of foreign banks (word "National" or initials "N.A." appear in or after bank's name) Federal Reserve System member banks (except national banks, and federal branches/agencies of foreign banks) Savings associations and federally chartered savings banks (word "Federal" or initials "F.S.B." appear in federal institution's name) Federal credit unions (words "Federal Credit Union" appear in institution's name) Banks that are state-chartered, or are not Federal Reserve System members Air, surface, or rail common carriers regulated by former Civil Aeronautics Board or Interstate Commerce Commission Activities subject to the Packers and Stockyards Act, 1921

  • PLEASE CONTACT:

  • Federal Trade Commission Bureau of Consumer Protection - FCRA Washington, DC 20580 * 202- 326-3761 Office of the Comptroller of the Currency Compliance Management, Mail Stop 6-6 Washington, DC 20219 * 800-613-6743 Federal Reserve Board Division of Consumer & Community Affairs Washington, DC 20551 * 202- 452-3693 Office of Thrift Supervision Consumer Programs Washington, DC 20552 * 800-842-6929 National Credit Union Administration 1775 Duke Street Alexandria, VA 22314 * 703-518-6360 Federal Deposit Insurance Corporation Division of Compliance & Consumer Affairs Washington, DC

  • 20429 * 800-934-FDIC

  • Department of Transportation Office of Financial Management Washington, DC 20590 * 202-366- 1306 Department of Agriculture Office of Deputy Administrator - GIPSA Washington, DC 20250 * 202- 720-7051

  • FOR SECURITY SCREENING PURPOSES

  • APPLICATION FOR A NON-EMPLOYEE, SECURITY CLEARANCE ELIGIBILITY DETERMINATION BY MY EMPLOYER'S CLIENT FOR CERTAIN RESTRICTED/LIMITED ACCESS TO MY EMPLOYER'S CLIENT'S CUSTOMERS, FACILITIES AND CONSTRUCTION SITES; AND OTHER INSTRUCTIONS, WAIVERS AND AGREEMENTS BY ME

  • 1.request, authorize, direct and instruct my employer (hereinafter referred to as "my employer") to deliver to my employer's client, and/or my employer's client's agents, any and all personal information that my employer now has, and later comes into possession of, regarding my criminal history, or lack thereof; driving record; drug screenings; workman comp claims; truncated social security number, addresses and date of birth verifications; judgments; public records; social records; private records, and evictions and etc., in order that my employer's client may make a separate, non-employee determination regarding my eligibility for a security clearance for certain restricted/limited access to my employer's client's customers, facilities and construction sites based on my employer's client's separate, non-employment security clearance criteria.

    2.I understand that my employer's client, and my employer's client's agents, are not my employers or prospective employers, and they owe me no duties whatsoever as an employer.

    3.I understand that my employer has a contract with their client, to provide sales, marketing, collections, installation, and other services of various types, which services I may be providing in some way to my employer's client's customers on behalf of my employer and that I may need access to my employer's client's customers, facilities and/or construction sites to do SO. I also understand that to have access to my employer's client's customers, facilities and/or construction sites that such access necessitates a separate security clearance regarding me conducted by my employer or its agents.

    I understand that this security clearance of my employer's client is similar in nature as if my client had a contract with the government. The government would require that I also go through the government separate security clearance vetting before I could have access to the government property. The government would not be my employer in such a situation just as my employer's client is not my employer in this situation.

    4.I understand and agree that my employer's client's non-employee, security clearance eligibility determination is separate from my employer's in-house employment hiring criteria or employee screening process and that only my employer makes decisions about my employment. I understand that to gain access to my employer's client's customers, facilities and/or construction sites I must pass my employer's client's security clearance criteria, which eligibility determination is separate from my employer's decision about my employment. I understand that any decision made about qualifying for such a security clearance for purposes of access to my employer's client's customers, facilities or

  • construction sites is made solely by my employer's client and no one else. I also understand that only my employer's client makes the rules and decisions about their own security clearance for access and NOT my employer.

    5.understand that if I pass my employer's client's security clearance criteria, I may be issued a security clearance card granting me specific and restricted access to my employer's client's customers, facilities and/or constructions sites. I also understand and agree that a security clearance decision by my employer's client is not subject to any individualized assessment as I understand and agree that my employer's client and its agents are not my employer, but rather, my employer is an independent contractor for its client who is demanding a separate non-pre-employment security clearance.

    I 6.further request, authorize, direct, and instruct any and all governmental agencies, private entities, companies and/or individuals to release any and all information relating to me to my employer's client, or its agents, in an effort for my employer's client, or its agents to perform a determination for my eligibility for my employer's client's security clearance.

    7.I understand that my employer's client, and/or its agents, may need a copy of my social security card, driver license and/or other personal documentation, including, but not limited to, police reports, plea agreements, probation or parole information and/or other information to complete its determination for eligibility for my employer's client's security clearance, and I agree to fully cooperate with the my employer's client, and its agents, and to assist them to complete my eligibility determination.I understand that even if I do cooperate that my employer's client, and its agents, have no duty to complete an investigation(s) or determination for eligibility for me for my employer's client's security clearance.

    8.I understand that my employer's client, and its agents, have no duty to me whatsoever to complete or to issue an eligibility determination for a security clearance, for any reason or no reason, and without

    9.I hereby release my employer from any liability whatsoever for releasing my personal information to its client, or its clients' agents, as I have specifically instructed my employer to release all of my personal information that they may ever receive about me and from any source.

    10. I agree, desire, request and instruct that any claim, dispute or controversy linked to, arising out of, or in any way related to, or associated with: my employer releasing my personal information to my employer's client, or its agents; my employer's client, or its agents, making any determination or adjudication of eligibility for a security clearance; failure of my employer's client, or its agents, to complete my eligibility determination or adjudication for employer's clients security clearance; my employer's clients, or its agents, making a determination or adjudication of not issuing me security clearance; the investigation performed or the consumer reports prepared by the credit reporting agency; any alleged or actual violation of federal, state, county or local statute, act, rule, law or ordinance by my employer, my employer's client's, or its agents, or the credit reporting agency that performed the original background investigations and prepared the consumer report delivered to my employer; any alleged or actual violation of ANY federal, state, county, or local statute, act, rule, law or ordinance, or; any other reason whatsoever related to or arising out of anything to do with a security clearance, all of

  • which issues shall all be decided solely and only by arbitration and NOT through any federal, state, county or local court system.

    11. I warrant that my employer has provided me with a copy of its client's security clearance criteria upon which its client, or its client's agents, may determine or adjudicate my eligibility for my employer's client's security clearance. I have read and understand the applicable security clearance criteria of my employer's client and agree with the eligibility determination factors and that said factors and eligibility in not my employer's employment screening criteria.

    12. I specifically waive any rights to join any claim(s) with claims of others in any form of class action or any similar procedure regarding any claim, dispute or controversy linked to, arising out of, or in any way related to, or associated with: my employer releasing my personal information to my employer's client, or its agents; my employer's client, or its agents, making any determination or adjudication of eligibility for a security clearance; failure of my employer's client, or its agents, to complete my eligibility determination or adjudication for employer's clients security clearance; my employer's clients, or its agents, making a determination or adjudication of not issuing me security clearance; the investigation performed or the consumer reports prepared by the credit reporting agency; any alleged or actual violation of federal, state, county or local statute, act, rule, law or ordinance by my employer, my employer's client's, or its agents, or the credit reporting agency that performed the original background investigations and prepared the consumer report delivered to my employer; any alleged or actual violation of ANY federal, state, county, or local statute, act, rule, law or ordinance, or; any other reason whatsoever related to or arising out of anything to do with a security clearance.

    13. Furthermore, I specifically agree that for any claim, dispute or controversy linked to, arising out of, or in any way related to, or associated with any scenario or type of claim as set forth in paragraphs 10 & 12 above, that I waive any and all rights to a jury trial or to a trial by a judge.

    14. I agree that any claim, dispute, or controversy of any kind whatsoever linked to, related to, arising out of or regarding any scenario or type of action as set forth in paragraphs 10 or 12 above shall be brought through arbitration pursuant to the American Arbitration Association rules. Additionally, I specifically waive any and all rights to appeal of the arbiter's or arbiters' decision in arbitration.I further specifically agree that Mesa, Arizona, is the exclusive venue and jurisdiction for arbitration. Lastly, notwithstanding any rules to the contrary, I agree that each party shall be responsible for their own attorney fees and costs for any claims.

    15. I agree that any cause of action against my employer, my employer's client, or my employer's client's agents, must be filed within one calendar year from the time any claim or cause of action, or any such claim shall forever be barred.

    16. Notwithstanding, if any statute, act, rule, regulation, or other applicable law or ordinance prohibits any clause, provision, or sentence in this agreement, then that applicable statute, act, regulation, law, or ordinance shall govern any prohibited clause, provision or sentence and any offending clause, provision or sentence in this agreement shall be disregarded and excluded and shall not constitute a violation thereof and the remainder of the agreement shall be fully enforceable. The remainder of the agreement not considered to violate any such statute, act, rule, regulation, law, or ordinance shall remain in full force.

  • 17. If I qualify for a Phase 2 non-pre-employment access security clearance for my employer's client I agree:

    To wear the security clearance badge in plain view whenever I am in the scope of my employment with my employer when in any way servicing a customer of my employer's client, or when I am in or on a facility or construction site of my employer's client. To allow anyone to scan the security clearance badge, including all of my employer's client's representatives. That the security clearance badge is the property of my employer's client and that I will report a lost or stolen badge to my employer immediately. That I must and will return the badge to my employer immediately upon termination from my employer for any reason, and that failure to do SO is considered theft and may affect my future ability to obtain another non-employment security clearance from my employer's client. To contact my employer or my employer's client directly if I suspect any fraud or misuse of my badge or anyone else's badge. That my employer's client's security clearance badge may be transferred but must first be returned to my original employer prior to issuance of a new badge for a new employer. My employer and/or my employer's client retain the absolute right to deactivate and retrieve the security clearance badge at any time, for any reason.

    18. I certify and warrant that all the information contained in this request, authorization, directive, and instructions in this document are true and correct. I agree that if a security clearance is granted to me that it may be terminated at any time for any reason, or no reason, by my employer or my employer's client.

    I have fully read this entire document, understand the content, and I agree to all of its contents. If I had any questions, I have consulted my employer.

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