Q3. New QSI Employee - USA Passport Holder

1. You will submit your fingerprints to SecurTest for an FBI Background Check.
2. SecurTest will also perform a U.S.-based background check of county and states you have resided.
3. You will be provided with FASTscreen® questions.
4. Foreign countries that you lived in the last 10 years, not as a visitor or in an internship program, will have a SecurTest International Background Check.
5. SecurTest will check Foreign and USA Watchlists.
As part of your application, SecurTest, Inc. will conduct your background check. Please read the following Consumer Authorization form in its entirety. The language in the disclosure statements is required under the Fair Credit Reporting Act. SecurTest’s background investigation is restricted to verification of your identity, verification of your Social Security Number, and a comprehensive criminal conviction search.

An important feature of the SecurTest background check includes iReviewNow®, a patented solution that allows you to view your report at the same time we do. Thus, please provide your email and cell phone number so that SecurTest can send you your report or information on how to securely view it online. You are an important part of the background screening process. Reviewing your report will ensure that you have authenticated its accuracy, identified any inaccuracies, file any disputes, explain any information, and provide any self-improvement steps you wish us to consider.

iReviewNow, LLC is not a consumer reporting agency, but the exclusive system that allows you to instantly view and comment on your background report.

The information you provide is secured and is neither sold nor redistributed by SecurTest or iReviewNow, LLC. Be sure to carefully complete each form. You may contact SecurTest at (800) 445-8001 or compliance@securtest.com if you have any questions. Thank you for your participation and cooperation in this important step.

You must answer each question, and scroll down, and press "Next."

The website and form are confidential and secure. You can be confident that your personal identifiers are protected and encrypted.
This authorization is required for us to complete your background check for Quality Schools International (hereafter "QSI"). The information you provide in this form is confidential and secure.

By completing the authorization online, you hereby certify that your electronic signature may be used as if it were your original handwritten signature by iReviewNow, SecurTest, Inc., and/or court researchers, investigators, or government entities to verify your authorization for your background check. You hereby give consent for SecurTest, Inc. to periodically re-check your background report without further notice or consent.

You may complete this authorization online by pressing "Next." The authorization will not be complete until you click the "Submit" button on the final page. You must complete this authorization in one sitting. Your information is SSL encrypted and secure.
I understand and agree*

In the space below, please list the payment code provided to you by QSI.*
Please verify and re-enter the payment code below*

Please note, regardless of your state of residency, you will have automatic access to your report through SecurTest or iReviewNow.
VI. I understand that if I am a resident of California, Minnesota, Oklahoma, Connecticut, or New York, I may obtain a copy of the background report.

I am a resident of California and want a copy of my report.I am a resident of Minnesota and want a copy of my report.I am a resident of Oklahoma and want a copy of my report.I am a resident of Connecticut and want a copy of my report.I am a resident of New York and want a copy of my report.I AM a resident of one of the listed states and do not wish a copy of my report.I AM NOT A CURRENT RESIDENT OF ANY OF THESE STATES.
First Name*
Last Name*
Middle Name (if any)
Suffix/Prefix (if any)
Full Maiden Name (if any; first, middle, and last)

Have you ever used any other Name(s), including married names?*

YesNo
Please list any other Name(s) Used. If you have used multiple names, please separate each name by pressing Enter.
Select the QSI location or Country at which you are employed or applying*
Current FULL address. It must be a FULL and COMPLETE Address.*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
NOTE: Fingerprinting assistance may be limited outside the United States

The following information is required by courts, law enforcement agencies, and other entities for positive identification purposes when checking public, government or official records. It is confidential and will not be used for any other purposes. You MUST answer each question.
Your Birth Date*

MonthDayYear
Do you have a Social Security Number?*

YesNo
Your Social Security Number
Numbers only (no dashes).
Your father's full name, including First, Middle and Last
Your mother's full maiden name, including First, Middle and Last
Your Passport Number
Country Passport Issued
NOTE: Fingerprint-based background screening services are only available to US Citizens and Lawful Permanent Residents ('Green Card' holders).

List each City and State in the USA that you have lived in the last 10 years (List on separate lines.)*
Current Residence Address, if different than above (Not a PO Box)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Dates you have lived at your current address (mm/yy to mm/yy or mm/yy to current)
Number of months you have lived at your current address.
Mailing Address, if different than above

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Who must be fingerprinted? The purpose of the fingerprints is to conduct a US based background check. So, who should be fingerprinted?

1. US Citizens must submit fingerprints.
2. Non-US Citizens that have lived in the US in the past 10 years (past your 18th birthday).

Who does not need to be fingerprinted?

NON-US CITIZENS that have not lived in the U.S. will not be required to submit fingerprints.

Finding a fingerprinting location in the USA. Generally, your local Sheriff's Office provides fingerprinting services.

Finding a fingerprinting location outside the USA. You will need to take the fingerprint card and FBI information form to be fingerprinted. Your prints must be rolled in ink on the FBI card and meet the legibility standards of the FBI. Contact the local US Embassy or Consulate to determine if they can fingerprint you. You may need to contact local law enforcement agencies as well. Mail by Certified Mail or send by Overnight Express for faster processing of the FINGERPRINT CARD and FBI INFORMATION FORM in a large thick envelope that protects the card from being folded or bent to the address we will provide to you in our email. We recommend that you use a certified carrier, such as FedEx. United Parcel Service (UPS) and DHL Express. Additional instructions will be emailed to you.
In order to ensure we conduct the proper screenings for you, please select one of the following:*

1. I have resided ONLY in the USA.2. I have resided in the USA and in one or more countries nine (9) months or more within the past 10 years at the minimum age of 18 years or older where my residency was not due to a college internship or study abroad program. (Where you resided in a non-US country as a college intern, then select option 2.)3. I have never lived in the United States and have only been a resident of a foreign country

1. Country Name*
1st Foreign (non-USA) country address, including country. It must be a FULL and COMPLETE Address.*

Street Address

Street Address Line 2

CityRegion/Province

Postal / Zip CodeCountry
1D. Dates you lived in this country (example mm/yyyy to mm/yyyy)*
1M.How many months did you live in this country?*
#2 Have you resided in another foreign country in the past 10 years and were 18 or older?*

YesNo

2. Country Name*
2nd Foreign (non-USA) country address, including country.It must be a FULL and COMPLETE Address.*

Street Address

Street Address Line 2

CityRegion/Province

Postal / Zip CodeCountry
2D. Dates you lived in this country (example mm/yyyy to mm/yyyy)*
2M. How many months did you live in this country?*
#3 Have you resided in another foreign country in the past 10 years and were 18 or older?*

YesNo

3. Country Name*
3rd Foreign (non-USA) country address, including country.It must be a FULL and COMPLETE Address.*

Street Address

Street Address Line 2

CityRegion/Province

Postal / Zip CodeCountry
3D. Dates you lived in this country (example mm/yyyy to mm/yyyy)*
3M. How many months did you live in this country?*
#4 Have you resided in another foreign country in the past 10 years and were 18 or older?*

YesNo

4. Country Name*
4th Foreign (non-USA) country address, including country.It must be a FULL and COMPLETE Address.*

Street Address

Street Address Line 2

CityRegion/Province

Postal / Zip CodeCountry
4D. Dates you lived in this country (example mm/yyyy to mm/yyyy)*
4M. How many months did you live in this country?*
#5 Have you resided in another foreign country in the past 10 years and were 18 or older?*

YesNo

5. Country Name*
5th Foreign (non-USA) country address, including country. It must be a FULL and COMPLETE Address.*

Street Address

Street Address Line 2

CityRegion /Province

Postal / Zip CodeCountry
5D. Dates you lived in this country (example mm/yyyy to mm/yyyy)*
5M. How many months did you live in this country?*

Email Address*

Confirmation Email
Your Cell Phone or Contact Number*

Area CodePhone Number
Alternate Phone Number

Area CodePhone Number

Stand-alone Single-Page Form FCRA Summary of Rights

A Summary of Your Rights Under the Fair Credit Reporting Act

Para información en español, visite www.consumerfinance.gov/es, o escriba: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20006

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 the 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 20006.

§        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:

§        a person has taken adverse action against you because of information in your credit report;

§        you are the victim of identify theft and place a fraud alert in your file;

§        your file contains inaccurate information as a result of fraud;

§        you are on public assistance;

§        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 from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-567- 8688.

§        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.

Consumers Have the Right To Obtain A Security Freeze

Pursuant to Title III of the “Economic Growth, Regulatory Relief, and Consumer Protection Act” (PL No. 115-174), 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.

To place a security freeze or fraud alert on your credit report please contact the following consumer reporting agencies:

Equifax
https://www.freeze.equifax.com/Freeze/jsp/SFF_PersonalIDInfo.jsp

https://www.alerts.equifax.com/AutoFraud_Online/jsp/fraudAlert.jsp

Experian

https://www.experian.com/freeze/center.html
https://www.experian.com/fraud/center.html

TransUnion

https://www.transunion.com/credit-freeze/credit-freeze-faq.page

https://www.transunion.com/fraud-victim-resource/place-fraud-alert
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:

TYPE OF BUSINESS: CONTACT:

1.a. Banks,saving sassociations, andcredit unions with total assets of over $10billion and their affiliates

Consumer Financial Protection Bureau * 1700 G Street, N.W. * Washington, DC 20552

b. Such affiliates that are not banks, savings associations, or credit unions also shouldlist,

FederalTradeCommission:Consumer * in addition to the CFPB:

Response Center–FCRA * 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

Office of the Comptroller of the Currency * Customer Assistance Group * 1301 McKinney Street, Suite 3450 * Houston, TX 77010-9050

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

Federal Reserve Consumer Help Center * P.O. Box 1200 * Minneapolis,MN55480

c. Non member Insured Banks, Insured State Branches of Foreign Banks, and insured state savings associations

FDIC Consumer Response Center * 1100 Walnut Street, Box #11 * Kansas City, MO 64106

d. Federal Credit Unions

National Credit Union Administration Office of Consumer Protection (OCP) Division of Consumer Compliance and Outreach (DCCO)

1775 Duke Street * Alexandria, VA22314

3. Aircarriers

Asst. General Counsel for Aviation Enforcement & Proceedings * Aviation Consumer Protection Division * DepartmentofTransportation * 1200 New Jersey Avenue, S.E. Washington, DC 20590

4. Creditors Subject to the Surface Transportation Board

Office of Proceedings, Surface Transportation Board * Department of Transportation

* 395 E Street, S.W. * Washington, DC 20423

5. Creditors Subject to the Packers and Stockyards Act, 1921

Nearest Packers and Stockyards Administration area supervisor

6. Small Business Investment Companies

Associate Deputy Administrator for Capital Access * United States Small Business Administration * 409 Third Street, S.W., 8thFloor * Washington, DC 20416

7. Brokers and Dealers

Securities and Exchange Commission * 100 F Street, N.E. * Washington, DC 20549

8. Federal Land Banks, Federal Land Bank Associations, Federal Intermediate Credit

Banks, and Production Credit Associations

Farm Credit Administration * 1501 Farm Credit Drive McLean, VA 22102-5090

9. Retailers, Finance Companies, and All Other Creditors Not Listed Above

FTC Regional Office for region in which the creditor operates or FederalTrade Commission: Consumer ResponseCenter – FCRA * Washington, DC 20580 * (877) 382-4357

Are you a CURRENT resident of California?*

YesNo

Stand-alone Form - Calif

California Disclosure Regarding Employment Background Report - NOTICE REGARDING BACKGROUND CHECKS PER CALIFORNIA LAW

The Employer (“Company”) intends to obtain information about you for employment screening purposes from a consumer reporting agency. Thus, you can expect to be the subject of “investigative consumer reports” and/or “consumer credit reports” obtained for employment purposes. Such reports may include information about your character, general reputation, personal characteristics and mode of living. With respect to any investigative consumer report from an investigative consumer reporting agency (“ICRA”), the Company may investigate the information contained in your employment application and other background information about you, including but not limited to obtaining a criminal record report, verifying references, work history, your social security number, your educational achievements, licensure, and certifications, your driving record, and other information about you, and interviewing people who are knowledgeable about you. The results of this report may be used as a factor in making employment decisions. The source of any investigative consumer report (as that term is defined under California law) will be SecurTest, Inc., 600 Grand Panama Blvd, Suite 202, Panama City Beach, FL 32407; tel. # 800.445.8001; www.securtest.com. The Company agrees to provide you with a copy of an investigative consumer report when required to do so under California law.

Under California Civil Code section 1786.22, you are entitled to find out what is in the Investigative Consumer Reporting Agency’s (ICRA) file on you with proper identification, as follows:
- In person, by visual inspection of your file during normal business hours and on reasonable notice. You also may request a copy of the information in person. The ICRA may not charge you more than the actual copying costs for providing you with a copy of your file.
- A summary of all information contained in the ICRA’s file on you that is required to be provided by the California Civil Code will be provided to you via telephone, if you have made a written request, with proper identification, for telephone disclosure, and the toll charge, if any, for the telephone call is prepaid by or charged directly to you.
- By requesting a copy be sent to a specified addressee by certified mail. ICRAs complying with requests for certified mailings shall not be liable for disclosures to third parties caused by mishandling of mail after such mailings leave the ICRAs.
“Proper Identification” includes documents such as a valid driver’s license, social security account number, military identification card, and credit cards. Only if you cannot identify yourself with such information may the ICRA require additional information concerning your employment and personal or family history in order to verify your identity.

The ICRA will provide trained personnel to explain any information furnished to you and will provide a written explanation of any coded information contained in files maintained on you. This written explanation will be provided whenever a file is provided to you for visual inspection. You may be accompanied by one other person of your choosing, who must furnish reasonable identification. An ICRA may require you to furnish a written statement granting permission to the ICRA to discuss your file in such person’s presence.

Please check this box if you would like to receive a copy of an investigative consumer report or consumer credit report at no charge if one is obtained by the Company whenever you have a right to receive such a copy under California law.

Send me a copy of my completed report.
SecurTest California Safeguards: Pursuant to California laws, SecurTest does not report the following information, except where required by law or federal regulation:

§        Report criminal records that did not result in a conviction.

§       Report records of arrest, indictment, information, misdemeanor complaint, or conviction of a crime that, from the date of disposition, release, or parole, antedates the report by seven (7) years.

§        Report records where it is found that a full pardon was granted or where the court sealed or expunged the record.

§        Report criminal convictions involving Marijuana that is older than two (2) years from the date of conviction.

§        Report criminal conviction involving possession, use, influence, paraphernalia, or presence during use of Marijuana that is older than two (2) years from the date of conviction.

* We do not perform a credit check unless you have signed a seperate authorization.
I am a current resident of the City of Los Angeles, California*

YesNo

Stand-alone Form - LA

City of Los Angeles CALIFORNIA

ERIC GARCETTI MAYOR

NOTICE TO APPLICANTS & EMPLOYEES FAIR CHANCE INITIATIVE FOR HIRING ORDINANCE

This Employer is subject to the Fair Chance Initiative for Hiring Ordinance (FCIHO) (LAMC 189.00).

THESE ARE YOUR RIGHTS…

1. Employers cannot inquire about or seek information about an Applicant’s Criminal History until after a Conditional Offer of Employment has been made to the Applicant*.
- This includes job solicitations and applications or during any conversations or interviews
2. If an Employer decides to rescind an offer of employment based on information discovered during the criminal background check, the Employer is required to perform an Individualized Assessment.
- Individualized Assessment - a written assessment that effectively links the specific aspects of the Applicant’s Criminal History with risks inherent in the duties of the Employment position sought by the Applicant.
- If the offer is rescinded, the Applicant must receive:
o Written notification

o Copy of the Individualized Assessment, and

o Copies of any documentation used in the Employer’s decision

3. The Applicant has the right to the Fair Chance Process.
- The Applicant has the opportunity to provide information or documentation to an Employer regarding the accuracy of his/her Criminal History or Criminal History Report or that should be considered in the Employer’s assessment, such as evidence of rehabilitation or other mitigating factors.
- The Employer is required to hold the job open for at least five (5) days from the date notification of a rescinded offer of employment to allow an Applicant to submit such documentation, and, the Employer is required to review any documentation in order to reassess their decision.
FOR ADDITIONAL INFORMATION OR ASSISTANCE, CALL:

City of Los Angeles * Department of Public Works * Office of Contract Compliance * 1149 S. Broadway Street, Suite 300 * Los Angeles, CA 90015 * Phone: (844) WagesLA – Email: WagesLA@lacity.org

*Note: Not all Applicants/Employees are covered under the FCIHO. Please see ordinance (LAMC 189.00) for more details.

Form FCIHO, Rev. 12/16

==================================

City of Los Angeles CALIFORNIA

ERIC GARCETTI

MAYOR

AVISO PARA SOLICITANTES Y EMPLEADOS ORDENANZA DE LA INICIATIVA DE OPORTUNIDAD JUSTA PARA LA CONTRATACIÓN

Éste empleador está sujeto a la Ordenanza de la Iniciativa de Oportunidad Justa Para la Contratación (Fair Chance Initiative for Hiring Ordinance) (FCIHO) (LAMC 189.00).

ÉSTOS SON SUS DERECHOS…

1. Los empleadores no deben preguntar al solicitante sobre los antecedentes penales hasta despúes de que se le ha dado al solicitante una oferta condicional de empleo.
- Ésto incluye solicitaciones y solicitudes de empleo o durante cualquier tipo de conversaciones o entrevistas
2. Si el empleador decide revocar la oferta de empleo como resultado de la investigación de antecedentes, el empleador está obligado a realizar una evaluación individualizada.
- Evaluación Individualizada – Un análisis por escrito de las funciones y responsabilidades del trabajo, los antecedentes penales del solicitante, y cualquier otro factores que pueden afectar a la decisión de contratación.
- Si se retiró la oferta, el solicitante debe recibir:
  - Un aviso por escrito o Una copia de la evaluación individual, y
  - Copias de todos los documentos que el empleador utilizó a llegar a la decisión
3. El solicitante tiene el derecho al proceso de la Oportunidad Justa.

El solicitante tiene cinco (5) días desde la fecha cuando recibió el aviso de retiro de oferta para juntar y entregar documentos que muestra la prueba de rehabilitación y/o errores en la investigación de antecedentes. Se requiere que los empleadores examinen cualquier documentación presentada para reexaminar su decisión.

PARA MÁS INFORMACIÓN O ASISTENCIA, PUEDE LLAMAR A:

City of Los Angeles * Department of Public Works * Office of Contract Compliance * 1149 S. Broadway Street, Suite 300 * Los Angeles, CA 90015 * Phone: (844) WagesLA – Email: WagesLA@lacity.org

*Note: Not all Applicants/Employees are covered under the FCIHO. Please see ordinance (LAMC 189.00) for more details. Form FCIHO, Rev. 12/16

I am a current resident of San Francisco, California*

YesNo

Stand-alone Form - SF

CITY AND COUNTY OF SAN FRANCISCO

EDWIN M. LEE, MAYOR

NOTICE TO JOB APPLICANTS AND EMPLOYEES

San Francisco Fair Chance Ordinance Police Code, Article 49

Starting August 13, 2014, the Fair Chance Ordinance (San Francisco Police Code, Article 49) requires employers to follow strict rules regarding the use of arrest and conviction records in hiring and employment decisions. The ordinance covers job applicants and employees who would be or are performing work in whole, or in substantial part, in San Francisco and applies to employers who have 20 or more employees (regardless of the employees’ locations).

Certain matters are off-limits. An employer may never ask about, require disclosure of, or consider: an arrest not leading to a conviction (other than an unresolved arrest that is still undergoing criminal investigation or trial); participation in a diversion or deferral of judgment program; a conviction that has been expunged or made inoperative; any determination in the juvenile justice system; a conviction more than 7 years old; and a criminal offense other than a felony/misdemeanor. Matters that are off-limits cannot be used by the employer for any reason at any stage of the hiring process.

An employer cannot ask about an individual’s conviction history or unresolved arrests at the start of the hiring process. This includes through a job application form, informal conversation, or otherwise.

A mandatory interactive process for matters not off-limits. Only after a live interview has been conducted, or a conditional offer of employment made, is the employer allowed to ask about an individual’s conviction history (except as to matters that are off-limits) and unresolved arrests. Only those convictions and unresolved arrests that directly relate to the individual’s ability to do the job may be considered in making an employment decision.

Before the employer may take an adverse action such as failing/refusing to hire, discharging, or not promoting an individual based on a conviction history or unresolved arrest, the employer must give the individual an opportunity to present evidence that the information is inaccurate, the individual has been rehabilitated, or other mitigating factors. The individual has seven days to respond, at which point the employer must delay any adverse action for a reasonable time and reconsider the adverse action. The employer must notify the individual of any final adverse action.

Evidence of rehabilitation include satisfying parole/probation; receiving education/training; participating in alcohol/drug treatment programs; letters of recommendation; and age at which the individual was convicted. Mitigating factors include coercion, physical or emotional abuse, and untreated substance abuse/mental illness, that contributed to the conviction.

Preemption. Where federal or state law imposes a criminal history requirement that conflicts with a requirement of the Fair Chance Ordinance, the federal or state law will apply.

No Retaliation. An employer may not take an adverse action against an applicant or employee for exercising their rights under the ordinance or cooperating with the Office of Labor Standards Enforcement OLSE.

If you need more information, or wish to report an employer that you believe has violated this ordinance, please contact the OLSE at 415-554-5192 or email FCE@sfgov.org.

OFFICE OF LABOR STANDARDS ENFORCEMENT City Hall, Room 430 1 Dr. Carlton B. Goodlett Place San Francisco CA 94102-4685 Tel. (415) 554-6235 Fax (415) 554-4791

====

Publicar donde esté accesible para quienes solicitan el empleo y los empleados. CIUDAD Y CONDADO DE SAN FRANCISCO

EDWIN M. LEE, ALCALDE

AVISO PARA LOS SOLICITANTES DE EMPLEO Y EMPLEADOS

Ordenanza de Oportunidades Equitativas de San Francisco

Código de Policía, Artículo 49

A partir del 13 de agosto de 2014, la Ordenanza de Oportunidades Equitativas (Código Policiaco de San Francisco, Artículo 49) requiere que los empleadores sigan reglas estrictas referentes al uso de los expedientes de arrestos y condenas al tomar decisiones de contratación y empleo. La ordenanza cubre a los solicitantes de empleos y empleados que estarían o están realizando su trabajo, o una parte sustancial del mismo, en San Francisco y se aplica a los empleadores que tengan 20 o más empleados (sin importar la ubicación de los empleados).

Está prohibido tocar ciertos asuntos. Un empleador nunca puede preguntar, requerir la divulgación de, o considerar: un arresto que no haya resultado en una condena (que no sea un arresto no resuelto que actualmente esté bajo investigación penal o juicio); participación en un programa de justicia alternativa o de fallo diferido; una condena que haya sido cancelada o declarada inoperante; cualquier determinación en el sistema de justicia juvenil; una condena de más de 7 años de antigüedad; y una infracción penal que no sea un delito mayor o delito menor. El empleador no puede utilizar los asuntos que están prohibidos para ningún propósito, en ninguna etapa del proceso de contratación.

Un empleador no puede preguntar sobre el historial de condenas o de arrestos no resueltos de una persona al inicio del proceso de contratación. Esto incluye preguntar mediante un formulario de solicitud de empleo, una conversación informal o de otra forma.

Un proceso interactivo obligatorio para asuntos que no estén prohibidos. Sólo después de que se haya hecho una entrevista en persona, o se haya hecho una oferta condicional de empleo, el empleador tiene permitido hacer preguntas sobre el historial de condenas de una persona (excepto sobre asuntos que estén prohibidos) y arrestos no resueltos. Sólo se pueden tomar en cuenta las condenas y los arrestos no resueltos que directamente se relacionen con la capacidad de la persona para hacer el trabajo al tomar la decisión del empleo.

Antes de que el empleador pueda tomar una acción adversa como no contratar, negarse a contratar, despedir, o no dar un ascenso a una persona con base en su historial de condenas o arrestos no resueltos, debe darle a la persona una oportunidad para presentar evidencia de que la información no es precisa, que la persona está rehabilitada, y otros factores atenuantes. La persona tiene 7 días para responder, en cuyo momento, el empleador debe posponer cualquier acción adversa durante un tiempo razonable y reconsiderar la acción adversa. El empleador debe avisar al individuo sobre cualquier acción adversa final.

La evidencia de rehabilitación incluye una libertad probatoria/bajo palabra satisfactoria; recibir educación/capacitación; participación en programas de tratamiento contra alcohol/drogas; cartas de recomendación; y la edad a la que la persona recibió la condena. Los factores atenuantes incluyen el chantaje, el maltrato físico o emocional, y la enfermedad no tratada mental o de consumo de sustancias que hayan contribuido con la condena.

Aplicación preferente. Cuando la ley federal o estatal impone un requisito de historial criminal que entra en conflicto con algún requisito de la Ordenanza de Oportunidades Equitativas, prevalecerá la ley federal o estatal.

Sin represalias. Un empleador no puede tomar una acción adversa contra un solicitante o empleado por ejercer sus derechos conforme a la ordenanza o por cooperar con la Oficina de Cumplimiento de los Estándares Laborales (Office of Labor Standards Enforcement, OLSE).

Si usted necesita más información, o si desea reportar a un empleador que usted crea que ha infringido esta ordenanza, por favor comuníquese con la OLSE al 415-554-5192 o por correo electrónico a FCE@sfgov.org.

====

張貼於求職者和雇員容易看到的地方。三藩市縣市長李孟賢求職者和雇員通告三藩市公平機會條例《警察法規》第 49 條

2014年8月13日起，《公平機會條例》（《三藩市員警法規》第49條》）要求雇主做出招聘和雇用決定時嚴格遵守使用被捕和犯罪記錄相關的規定。。本條例適用於將來或目前大部分時間在三藩市工作的求職者和雇員並適用於有20名或以上雇員的雇主（不考慮雇員的所在地）。

某些事項受到禁止。雇主任何時候不得問及、要求披露或者考慮求職者或雇員相關的以下事項：（1）未導致定罪的逮捕（仍在進行刑事調查或審理的除外）；（2）參與判決程序轉移或延期；（3）被刪除或宣告無效的有罪判決；（4）青少年司法系統的決定；（5）7年前的有罪判決；以及（6）重罪/輕罪以外的犯罪行為。

雇主在招聘過程開始時，不得問及個人的犯罪史或未定罪的逮捕。這包括透過職位申請表、非正式談話或其他方式的詢問。

不受禁止事項在聘用過程中必須遵守的規定。。僅可在進行現場面試或者提供有條件雇用之後，才准許雇主問及個人的定罪史（受到禁止的事項除外）和未定罪的逮捕。做出雇用決定時僅可考慮與個人從事該工作的能力直接相關的有罪判決和未定罪的逮捕。

雇主根據定罪史或未定罪的逮捕採取不/拒絕聘用、解雇或不晉升個人之前，雇主必須給予此人機會提交證據表明該資訊不準確、此人已改過自新或者其他減輕因素。此人有七天時間做出回應，在此期間雇主必須合理延遲時間並重新考慮該不聘佣決定。雇主必須通知此人任何最終的決定。

改過自新的證據包括令人滿意的假釋/緩刑；接受教育/培訓；參加酒精/毒品治療項目；推薦信；以及個人被判有罪的年齡。減輕因素包括促成有罪判決的脅迫、身體或精神虐待以及未得到治療的藥物濫用/精神疾病。

優先適用。如果聯邦或州法律規定的犯罪記錄要求與《公平機會條例》的要求互相衝突，則將適用聯邦或州法律。

禁止報復。雇主不得因求職者或雇員行使條例規定的權利或者配合勞工標準執行辦公室（OLSE），而對求職者或雇員採取報復行動。

如果您需要更多資訊或者想要舉報您認為違反本條例的雇主，請撥打415-554-5192或者發送電子郵件到FCE@sfgov.org聯繫OLSE。

Are you a CURRENT resident of the State of New York?*

YesNo

Stand-alone Form - NY

NEW YORK DISCLOSURE

NEW YORK CORRECTION LAW ARTICLE 23-A

LICENSURE AND EMPLOYMENT OF PERSONS PREVIOUSLY CONVICTED OF ONE OR MORE CRIMINAL OFFENSES

Section 750. Definitions.

751. Applicability.

752. Unfair discrimination against persons previously convicted of one or more criminal offenses prohibited.

753. Factors to be considered concerning a previous criminal conviction; presumption.

754. Written statement upon denial of license or employment.

755. Enforcement.

§750. Definitions. For the purposes of this article, the following terms shall have the following meanings:

(1) "Public agency" means the state or any local subdivision thereof, or any state or local department, agency, board or commission.

(2) "Private employer" means any person, company, corporation, labor organization or association which employs ten or more persons.

(3) "Direct relationship" means that the nature of criminal conduct    for   which      the person was convicted has a direct bearing on his fitness   or ability to perform one or more of the duties or responsibilities necessarily related to the license, opportunity, or job in question.

(4) "License" means any certificate, license, permit or grant of permission required by the laws of this state, its political subdivisions or instrumentalities as a condition for the lawful practice of any occupation, employment, trade, vocation, business, or profession. Provided, however, that "license" shall not, for the purposes of this article, include any license or permit to own, possess, carry, or fire any explosive, pistol, handgun, rifle, shotgun, or other firearm.

(5) "Employment" means any occupation, vocation or employment, or any form of vocational or educational training. Provided, however, that "employment" shall not, for the purposes of this article, include membership in any law enforcement agency.

§751. Applicability. The provisions of this article shall apply to any application by any person for a license or employment at any public or   private employer, who has previously been convicted of one or more criminal offenses in this state or in any other jurisdiction, and to any license or employment held by any person whose conviction of one or more criminal offenses in this state or in any   otherjurisdiction preceded such employment or granting of a license, except where a mandatory forfeiture, disability or bar to employment is imposed by law, and has not been removed by an executive pardon, certificate of relief from disabilities or certificate of good conduct. Nothing in this article shall be construed to affect any right an employer may have with respect to an intentional misrepresentation in connection with an application for employment made by a prospective employee or previously made by a current employee.

§752. Unfair discrimination against persons previously convicted of one or more criminal offenses prohibited. No application for any license or employment, and no employment or license held by    an individual, to which the provisions of this article are applicable, shall be denied or acted    upon adversely by reason of the individual's having been previously convicted of one or more criminal offenses, or by reason of a finding of lack of "good moral character" when such finding is based upon the fact that the individual has previously been convicted of one or more criminal offenses, unless:

(1) There is a direct relationship between one or more of the previous criminal offenses and the specific license or employment sought or held by the individual; or

(2) the issuance or continuation of the license or the granting or continuation of the employment would involve an unreasonable risk to property or to the safety or welfare of specific individuals or the general public.

§753. Factors to be considered concerning a previous criminal conviction; presumption. 1. In making a determination pursuant to section seven hundred fifty-two of this chapter, the public agency or private employer shall consider the following factors:

(a) The public policy of this state, as expressed in this act, to encourage the licensure and employment of persons previously convicted of one or more criminal offenses.

(b) The specific duties and responsibilities necessarily related to the license or employment sought or held by the person.

(c) The bearing, if any, the criminal offense or offenses for which the person was previously convicted will have on his fitness or ability to perform one or more such duties or responsibilities.

(d) The time which has elapsed since the occurrence of the criminal offense or offenses.

(e) The age of the person at the time of occurrence of the criminal offense or offenses.

(f) The seriousness of the offense or offenses.

(g) Any information produced by the person, or produced on his behalf, in regard to his rehabilitation and good conduct.

(h) The legitimate interest of the public agency or private employer in protecting property, and the safety and welfare of specific individuals or the general public.

2. In making a determination pursuant to section seven hundred fifty-two of this chapter, the public agency or private employer shall also give consideration to a certificate of relief from disabilities or a certificate of good conduct issued to the applicant, which certificate shall create a presumption of rehabilitation in regard to the offense or offenses specified therein.

§754. Written statement upon denial of license or employment. At the request of any person previously convicted of one or more criminal offenses who has been denied a license or employment, a public agency or private employer shall provide, within thirty days of a request, a written statement setting forth the reasons for such denial.

§755. Enforcement. 1. In relation to actions by public agencies, the provisions of this article shall be enforceable by a proceeding brought pursuant to article seventy-eight of the civil practice law and rules.
2. In relation to actions by private employers, the provisions of
this article shall be enforceable by the division of human rights
pursuant to the powers and procedures set forth in article fifteen of the executive law, and, concurrently, by the New York city commission on human rights.

I am a current resident of New York City (Manhattan, Brooklyn, Queens, The Bronx, Staten Island.*

YesNo

Stand-alone Form - NYC

Notice Regarding Credit Checks Per City of New York Law

In conjunction with my application for employment with the Client, I understand that the Client intends to obtain information for employment screening purposes from a consumer reporting agency (CRA). I understand that a consumer report may be obtained from the following CRA: SecurTest, Inc., 600 Grand Panama Blvd, Suite 202, Panama City Beach, FL 32407; tel. # 800.445.8001; www.securtest.com. A copy of their privacy policy may be requested. Pursuant to the city of New York administrative code Section 8-102, subdivision 29, the Client informs you that it may obtain a credit report about you from the above named CRA because you are seeking employment in the following position(s), or for the following reason(s):
- A position with (i) signatory authority over third party funds or assets valued at $10,000 or more, or (ii) fiduciary responsibility to the employer and authority to enter into financial agreements valued at $10,000 or more on behalf of the employer;
- A position with regular duties allowing an employee to modify digital security systems designed to prevent the unauthorized use of the employer’s or client’s networks or databases;
- A non-clerical position with regular access to trade secrets or national security/intelligence information;
- The employer is required to use an individual’s consumer credit history for employment purposes under state or federal law/regulations or by a self-regulatory organization (as defined by the Securities Exchange Act of 1934);
- A position as a police officer or peace officer, or various positions with a law enforcement or investigative function at the Department of Investigation or subject to background investigation by the Department of Investigation;
- A position requiring bonding under federal, state, or city law (e.g., certain positions in finance);
- A position requiring security clearance under federal or any state law.
I acknowledge receipt of the Notice Regarding Credit Checks Per New York City Law and A Summary of Your Rights Under the Fair Credit Reporting Act and certify that I have read and understand these documents. I further acknowledge that a telephonic facsimile (FAX) or photographic copy of this authorization shall be as valid as the original.

SecurTest does not obtain your credit report unless you complete a seperate authorization where the employer has identified one of the above requirements.

I am a current resident of Wisconsin.*

YesNo

Stand-alone Form - WI

Wisconsin Consumers Have the Right to Obtain a Security Freeze

Effective January 1, 2007, if you live in Wisconsin you have a right to place a "security freeze" on your credit report. A freeze will prohibit a credit reporting agency from releasing information in your credit report without your express authorization. A security freeze must be requested in writing by certified mail by you to each of the three consumer reporting agencies. The security freeze is designed to prevent an extension of credit, such as a loan or a new credit card, from being approved in your name without your consent. A freeze may protect you from identity theft. 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 approval of any subsequent request or application you make regarding a loan, credit, mortgage, or Internet credit card transaction, including an extension of credit at point of sale. As a result, if you plan on obtaining new credit, you should release your freeze approximately one week before seeking new credit.

Placing the Freeze on your Credit Report

To place a security freeze on your credit report, send your written request via certified mail to:

Equifax CSC Credit Services Security Freeze P O Box 674438 Houston, TX 77267-4438

Experian Experian Security Freeze P. O. Box 9554 Allen, TX 75013

TransUnion TransUnion Security Freeze P. O. Box 6790 Fullerton, CA 92834-6790

The fee to place a security freeze is $10.00 for each credit reporting agency. If you submit a copy of a valid police report that verifies you are a victim of identity theft, no fee will be charged. Include your complete name, complete address, social security number, date of birth and payment, if applicable. For your convenience there are form letters to each of the credit reporting companies available on www.privacy.wi.gov. The forms allow you to type in your personal information and print the letter or you may print the blank letter and write your information Written confirmation of the security freeze will be sent to you within 10 business days of receipt of the request.. It will include a personal identification number (PIN), and instructions for removing the security freeze or authorizing the release of your credit report for a specific period of time.

Removing the Freeze from your Credit Report

When you request a security freeze for your credit report, you will be provided a personal identification number (PIN) to use if you choose to remove the security freeze from your credit report or authorize the release of your credit report for a period of time after the security freeze is in place. Be sure to keep your personal identification number (PIN) in a secure place for use when needed. To remove your freeze either permanently or temporarily, you must contact the consumer reporting agency and provide all of the following:

(1) The personal identification number (PIN). (2) Proper identification to verify your identity. (3) The period of time for which the report shall be made available. (4) Payment of the appropriate fee.

A security freeze does not apply to those with which you have an existing account that request 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.

If You Are a Victim of Identity Theft

A victim of identity theft with a police report to verify the crime will not be required to pay the $10 fee to the credit reporting agencies in order to obtain a security freeze. Be prepared to submit a copy of the police report when requesting the freeze. No fee will be charged to remove or replace the freeze as long as the police report is included in all correspondence.

If you believe your identity has been stolen, contact the Wisconsin Office of Privacy Protection at 1-800-422-7128 or email us at WisconsinPrivacy@datcp.state.wi.us. Visit our website at privacy.wi.gov for more information.

I am a current resident of the State of Washington.*

YesNo

Stand-alone Form - WA

STATE OF WASHINGTON CONSUMER CREDIT REPORTING ACT

SUMMARY OF CONSUMER RIGHTS

The State of Washington Fair Credit Reporting Act (WFCRA) 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 the WFCRA. The WFCRA is modeled after the Federal Fair Credit Reporting Act. The same rights are provided under the Federal Fair Credit Reporting Act and you have received A Summary of Your Rights Under the Federal Fair Credit Reporting Act. You can get the complete text of WFCRA RCW 19.182, from the Washington Code Revisers Office, P.O. Box 40551, Olympia, WA, 98504, or online at http://apps.leg.wa.Gov/rcw/default.aspx?cite=19.182&full=true#19.182.070.

• You must be told if information in your file has been used against you. If a person takes an adverse action against you that is based, in whole or in part, on information contained in a consumer report, that person must tell you, and must give you the name, address, and telephone number of the consumer reporting agency that provided the information.

• You have a 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, although medical information may be withheld and given directly to your medical provider. You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You will not be charged for:
- a consumer report if a person has taken adverse action against you because of information in your credit report;
- the reinvestigation of information you dispute; or
- corrected reports resulting from the deletion of inaccurate or unverifiable information.
In addition, you are entitled to one free consumer report every 12 months, upon request. You may be charged a limited fee for a second or subsequent report requested by you during a 12 month period.

• You have a right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and you notify the consumer reporting agency directly of the dispute, the consumer reporting agency will reinvestigate without charge and record the current status of the disputed information before the end of thirty business days, unless your dispute is frivolous.

• Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Upon completion of the reinvestigation, if the information you disputed is found to be inaccurate or cannot be verified, the consumer reporting agency will delete the information and notify you of the correction.

If the reinvestigation does not resolve your dispute, you may file with the consumer reporting agency a brief statement setting forth the nature of your dispute. The statement will be placed in your consumer file and in any subsequent report containing the information you disputed.

• 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 ten 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 WFCRA specifies those with a valid need for access.

• You must be notified if reports are provided to employers. A consumer reporting agency may not give out information about you to employers without your knowledge. A potential employer must make a clear and conspicuous disclosure in writing to you or obtain your consent before obtaining a report. A current employer may not receive a report unless it has given you written notice that consumer reports may be used for employment purposes.

• You may limit “prescreened” offers of credit and insurance you get based on information in your credit report. You may elect not to receive unsolicited “prescreened” offers for credit and insurance by using the consumer reporting agency’s notification system to remove your name and address from 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).

• You may place a security freeze on your credit report. A security freeze prevents your credit file from being shared with potential creditors or insurance companies. You may request a security freeze by contacting the three credit bureaus, as follows: They may charge a fee for providing this service.

Equifax — 1-800-349-9960

Experian — 1‑888‑397‑3742

TransUnion — 1-888-909-8872

TransUnion LLC P.O. Box 2000 Chester, PA 19016

https://freeze.transunion.com

Experian Security Freeze P.O. Box 9554 Allen, TX 75013

www.experian.com/freeze

Equifax Security Freeze P.O. Box 105788 Atlanta, GA 30348

https://www.freeze.equifax.com

You may also contact SecurTest, Inc., the background screening provider, at (800) 445-8001 or by mail at 600 Grand Panama Blvd, Suite 202, Panama City Beach, FL 32407. SecurTest only provides the credit reports as reported by the credit bureaus.

• You may be able to block information resulting from identity theft from appearing on your credit report. If you are a victim of identity theft, a consumer reporting agency must permanently block misinformation resulting from that theft from appearing on your credit report. You must provide the consumer reporting agency with a copy of a police report as evidence of your claim before it can place the block on your report.

• 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 WFCRA, you may be able to sue in state or federal court.

COMPLAINTS

Any complaints by consumers under state law may be directed to:

Office of the Attorney General

Consumer Protection Division

800 5th Avenue, Suite 2000

Seattle, Washington 98104-3188

Phone 1-800-551-4636 or (206) 464-6684 * Fax (206) 389-2801 * Statewide Toll-Free TDD: 800 276-9883

Complaints May Be Made Via U.S. Mail or E-Mail .

Complaints: http://www.atg.wa.gov/FileAComplaint.aspx

(Include your U.S. Mail address with any complaint.)

Website & Forms: http://www.atg.wa.gov/

I am a resident of Vermont.*

YesNo

Stand-alone Form - VT

NOTICE REGARDING CREDIT CHECKS PER VERMONT LAW

Pursuant to Vermont Act No. 154 (S. 95), the Client informs you that it may obtain a credit report about you, for the following reason(s):

[_] The information is required by state or federal law or regulation;

[_] You seek to be/are employed in a position that involves access to “confidential financial information” (defined as “sensitive financial information of commercial value that a customer or client of the employer gives explicit authorization for the employer to obtain, process, and store and that the employer entrusts only to managers or employees as a necessary function of their job duties”);

[_] The Client is a financial institution as defined in 8 V.S.A. §11101(32) or a credit union as defined in 8 V.S.A. §30101(5);

[_] You seek to be/are employed in a position as a law enforcement officer, emergency medical personnel or firefighter as these terms are respectively defines in 20 V.S.A. §2358, 24 V.S.A. §2651(6) and 20 V.S.A. §3151(3)

[_] You seek to be/are employed in a position that requires a financial fiduciary responsibility to the Client or a Client’s clients, including the authority to issue payments, collect debts, transfer money or enter into contracts;

[_] You seek to be/are employed in a position that involves access to the Client’s payroll information;

[_] The Client can demonstrate that credit information is a valid and reliable predictor of employee performance in the your specific position of employment;

[✔] The Client will not obtain a consumer credit report on you.

Are you a CURRENT resident of New Jersey?*

YesNo

Stand-alone Form - NJ

A Summary of Your Rights Under New Jersey’s Fair Credit Reporting Act

Under the New Jersey Fair Credit Reporting Act (NJFCRA or the “Act”), an employer, before taking adverse employment action, is required to provide the applicant or employee with a summary of their rights under the Act with respect to consumer reports or investigative consumer reports obtained for employment purposes from a consumer reporting agency (CRA). This Summary is intended to serve that purpose.

You can find the complete text of the NJCRA, N.J. Stat. §§56:11-29 – 56:11-41, at the New Jersey State Legislature’s web site (http://www.njleg.state.nj.us/). You may have additional rights under the federal Fair Credit Reporting Act, 15 U.S.C. 1681-1681u, which is available on the Internet at the Federal Trade Commission’s website (http://www.ftc.gov).

• You must consent to the procurement for employment purposes of a report about you. Before an employer can obtain a report about you from a CRA, the employer must provide you with notice that it will request the report and obtain your consent to that request. A CRA may not give out information about you to the employer, or prospective employer, without your written consent.

• You must be told if information in your file has been used against you for employment purposes. An employer who uses information from a consumer or investigative consumer report to take action against you -- such as denying an application for employment or terminating employment -- must tell you that its decision is based in whole or in part on the report. The employer also must provide you with a description of your rights under the NJCRA and a reasonable opportunity to dispute with the CRA any information on which the employer relied.

• You have a right to know what is in your file. You may request and obtain all the information about you in the file of a CRA and a list of everyone who has recently requested your file. These disclosures may be made in person, over the telephone or by any other reasonable method available to the CRA. Additionally, you are entitled to one free consumer report every 12 months, upon request. You may be charged a limited fee for a second or subsequent report requested by you during a 12 month period.

• You have a right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and you notify the consumer reporting agency directly of the dispute, the CRA will reinvestigate without charge and record the current status of the disputed information before the end of thirty business days, unless your dispute is frivolous or irrelevant. The CRA must give you a written report of the investigation.

• Consumer reporting agencies must correct or delete inaccurate, incomplete or unverifiable information. Upon completion of the reinvestigation, if the information you disputed is found to be inaccurate or cannot be verified, the CRA will delete the information within 30 days after you dispute it and notify you of the correction. If the reinvestigation does not resolve your dispute, you may file with the CRA a brief statement setting forth the nature of your dispute. The statement will be placed in your consumer file and in any subsequent report containing the information you disputed.

• Consumer reporting agencies may not report outdated negative information. In most cases, a CRA may not report negative information that is more than seven years old, or bankruptcies that are more than ten years old.

• You may place a security freeze on your credit report. A security freeze prevents your credit file from being shared with potential creditors or insurance companies. You may request a security freeze by contacting by calling the following toll-free telephone number(s): TransUnion: 888-909-8872, Experian: 888-397-3742, Equifax: 800-685-1111 (NY residents please call 1-800-349-9960). TransUnion, Experian and Equifax can also be reached at the following addresses:

TransUnion LLC
P.O. Box 2000
Chester, PA 19016
https://freeze.transunion.com

TransUnion — 1-888-909-8872
Experian Security Freeze
P.O. Box 9554
Allen, TX 75013
www.experian.com/freeze

Experian — 1‑888‑397‑3742
Equifax Security Freeze
P.O. Box 105788
Atlanta, GA 30348
https://www.freeze.equifax.com
Equifax — 1-800-349-9960

A fee may be charged for providing this service.

• You may seek damages from violators. If a CRA, or in some cases, a user of consumer reports or a furnisher of information to a CRA violates the NJFCRA, you may be able to sue in state court.

COMPLAINTS

DIVISION OF CONSUMER AFFAIRS
Department of Law and Public Safety
124 Halsey Street
Newark, NJ 07102
Phone: 800-242-5846
973-504-6200

Are you a current resident of Minnesota?

YesNo

Notification of Rights for Minnesota Consumers Security Freeze Process

If you are a Minnesota resident, you have the right to place a “security freeze” on your credit report, which will prohibit us from releasing any information in your credit report without your express authorization, except to those with whom you have an existing account or a collection agency acting on behalf of the existing account, for purposes of reviewing (account maintenance, monitoring, credit line increases and account upgrades and enhancements) or collecting the account. Your information also may be used for the purposes of prescreening as provided for by the federal Fair Credit Reporting Act, even if a security freeze is on the report. A security freeze is designed to prevent credit, loans, and services from being approved in your name without your consent; however, using a security freeze may delay, interfere with, or prohibit the timely approval of any subsequent requests or applications regarding a new loan, credit, mortgage, insurance, government services or payments, rental housing, employment, investment, license, cellular phone, utilities, digital signature, Internet credit card transaction, or other services, including an extension of credit at point of sale.

To request a security freeze send all of the following via certified mail to:

• Equifax Security Freeze P.O. Box 105788 Atlanta, GA 30348

• Experian Security Freeze P.O. Box 9554 Allen, TX 75013

• TransUnion Security Freeze P O Box 2000 Chester, PA 19016

You must include your full name, with middle initial and generation, such as JR, SR, II, III, etc.; Social Security number; date of birth (month, day and year); current address and previous addresses for the past two years; and if applicable, a valid investigative report, a valid incident report, or a valid complaint or valid case number documenting identity theft with a law enforcement agency or the Department of Motor Vehicles (DMV). In addition, enclose one copy of a government issued identification card, such as a driver’s license, state ID card, etc., and one copy of a utility bill, bank or insurance statement, etc., and make sure that each copy is legible (enlarge if necessary), displays your name and current mailing address, and the date of issue (statement dates must be recent). We are unable to accept credit card statements, voided checks, lease agreements, magazine subscriptions or postal service forwarding orders as proof. Copies of any documents should be sent, and you should always retain your original documents.

Are you a current resident of Massachusetts?*

YesNo

Stand-alone Form - MA

Summary of Your Rights Under The Massachusetts Consumer Credit Reporting Act

You have the right to obtain a free copy of your credit file from a consumer credit reporting agency. You may be charged a reasonable fee not exceeding eight dollars. There is no fee, however, if you have been turned down for credit, employment, insurance, or rental dwelling because of information in your credit report within the preceding sixty days. The consumer credit reporting agency must provide someone to help you interpret the information in your credit file. Each calendar year you are entitled to receive, upon request, one free consumer credit report.

You have a right to dispute inaccurate information by contacting the consumer credit reporting agency directly. However, neither you nor any credit repair company or credit service organization has the right to have accurate, current, and verifiable information removed from your credit report. In most cases, under state and federal law, the consumer credit reporting agency must remove accurate, negative information from your report only if it is over seven years old, and must remove bankruptcy information only if it is over ten years old.

If you have notified a consumer credit reporting agency in writing that you dispute the accuracy of information in your file, the consumer credit reporting agency must then, within thirty business days, reinvestigate and modify or remove inaccurate information. The consumer credit reporting agency may not charge a fee for this service. Any pertinent information and copies of all documents you have concerning a dispute should be given to the consumer credit reporting agency.

If reinvestigation does not resolve the dispute to your satisfaction, you may send a statement to the consumer credit reporting agency to keep in your file, explaining why you think the record is inaccurate. The consumer credit reporting agency must include your statement about the disputed information in a report it issues about you.

You have a right to receive a record of all inquiries relating to a credit transaction initiated in the six months preceding your request, or two years in the case of a credit report used for employment purposes. This record shall include the recipients of any consumer credit report.

You have the right to opt out of any pre-screening lists compiled by or with the assistance of a consumer credit reporting agency by calling the agency’s toll-free telephone number or contacting the agency in writing. You may be entitled to collect compensation, in certain circumstances, if you are damaged by a person’s negligent or intentional failure to comply with the provisions of the credit report act.

INFORMATION CONCERNING THE PROCESS IN CORRECTING A CRIMINAL RECORD

1. If you have undergone a background check by an agency that has received a criminal record from the DCJIS, you may ask the agency to provide you with a copy of the criminal record. You may also request a copy of your adult criminal record from the Department of Criminal Justice Information Services, 200 Arlington Street, Suite 2200, Chelsea, MA 02150 or by calling (617)660-4640 or go to http://www.mass.gov/Eeops/docs/cjis/cori_request_personal.pdf

2. The DCJIS charges $25.00 fee to provide an individual with a copy of his/her criminal record.

You may complete an affidavit of indigency and request that the DCJIS waive the fee.

3. Upon receipt, review the record. If you need assistance in interpreting the entries or dispositions, please review the disposition code and “how to read a criminal record” on the DCJIS website www.mass.gov/cjis/cori/cori_bop.html

4. The DCJIS does not offer “walk-in” service but you may call our Legal Division at (617)660-4760 for assistance or the CARI Unit of the Office of the Commissioner of Probation at (617)727-5300.

5. If you believe that a case is opened on your record that should be marked closed, you may contact the Office of the Commissioner of Probation Department at the court where the charges were brought and request that the case(s) be updated.

6. If you believe that a disposition is incorrect, contact the Chief Probation Officer at the court where the charges were brought or the CARI Unit at the Office of the Commissioner of Probation and report that the court incorrectly entered a disposition on your criminal record.

7. If you believe that someone has stolen or improperly used your identity and were arraigned on criminal charges under your name, you may contact the Office of the Commissioner of Probation CARI Unit or the Chief Probation Officer in the court where the charges were brought. For a listing of courthouses and telephone numbers please see www.mass.gov/cjis/cori/cori_codes_court.html

8. In some situations of identity theft, you may need to contact the DCJIS to arrange to have fingerprints analysis conducted.

9. If there is a warrant currently outstanding against you, you need to appear at the court and ask that the warrant be recalled. You cannot do this over the telephone.

10. If you believe that an employer, volunteer agency, housing agency or municipality has been provided with a criminal record that does not pertain to you, the agency should contact the CORI Unit for assistance at (617)660-4640.

FAIR CREDIT REPORTING ACT NOTICE

In accordance with the Fair Credit Reporting Act (FCRA, Public Law 91-508, Title VI), this information may only be used to verify a statement(s) made by an individual in connection with legitimate business needs. The depth of information available varies from state to state. Status of updates is available on request. Although SecurTest, Inc. has used reasonable methods and standards in its background screening and collection of information and every effort has been made to assure accuracy, SecurTest relies on sources of information which are outside of the control of SecurTest, as they are county, state, federal, and other o cial records. Final veri cation of an individual’s identity and proper use of report contents are the responsibility of Quality Schools International. SecurTest, Inc.’s policy requires purchasers of these reports to have signed a Service Agreement. This assures SecurTest, Inc., providers of o cial records, and SecurTest researchers, background screening investigators, and sources for such information that users of your report will abide by the FCRA and other legal obligations. If information contained in this report is responsible for disquali cation, suspension or termination the requesting agency of this background report has agreed to give you immediate access to your SecurTest Report, iReviewNow, and your FCRA rights, among other required documentation.

By submitting my information, as the subject of the background check, I certify that I have received a copy of my FCRA Rights. I further a rm receipt of a copy of my SecurTest Background Report to the email provided and use of iReviewNow to verify the accuracy of the report.

I understand I can instantly review my report for FREE, identify errors or mistakes, report identity theft, dispute inaccuracies, provide comments using the iReviewNow Compliance System.

I agree to exclusively use iReviewNow to verify the accuracy of my background report, identify errors or mistakes, report identity theft, and dispute inaccuracies, and provide comments or feedback.

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

The CLIENT identified on the first page (“the Client”) 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 you credit history, 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 SecurTest, Inc., 600 Grand Panama Blvd, Suite 202, Panama City Beach, FL 32407; tel. # 800.445.8001; www.securtest.com. The scope of this disclosure is all-encompassing, however, allowing the Client to obtain from any outside organization all manner of consumer reports throughout the course of your employment to the extent permitted by law.
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I hereby authorize iReviewNow, LLC and SecurTest, Inc. to transmit a copy of my background report to me in a secure electronic manner. I understand that receiving a copy of my report, use of iReviewNow, or providing responses or disputes using iReviewNow is a free service, which allows me instant access and other valuable benefits described in the Terms and Conditions found at iReviewNow.com and below. I FURTHER AUTHORIZE iReviewNow, LLC and SecurTest to transmit a copy of my background report, including any FBI Report, to Quality Schools International (QSI) without further consent by me. I understand that I will be responsible for uploading my full report to QSI once I receive the report from SecurTest and have completed iReviewNow.*

I agree to the iReviewNow, LLC and SecurTest, Inc. terms and conditions.
INSTRUCTIONS FOR REQUESTING A COPY OF YOUR REPORT AT A FUTURE DATE:

You may go to iReviewNow.com to request a copy of your report in the future. You will be required to upload, scan color copies of your government issued identification, such as a driver’s license, state identification card, passport, birth certificate, or similar documentation to verify your identity. WE MUST HAVE YOUR DATE OF BIRTH, SOCIAL SECURITY NUMBER (where issued), ADDRESS, AND EMAIL TO FIND AND SEND YOU A COPY OF YOUR REPORT.
HOW TO CONTACT SECURTEST, INC.

SecurTest, Inc. ★ 600 Grand Panama Blvd. Ste 202, Panama City Beach, FL 32407★ (800) 445-8001 (toll-free to speak to SecurTest) ★ Fax (866) 580-4851 ★ compliance@securtest.com ★ compliance@iReviewNow.com ★ or by going to www.iReviewNow.com

I hereby authorize SecurTest, Inc. and iReviewNow, LLC (not a consumer reporting agency) and its assigns to transmit my background report, including any FBI Rap Sheet and/or International Background Reports, or other background reports (collectively "Report"), to Quality Schools International, its member schools, assigns, or affiliates (hereafter "QSI") following my receipt, review and approval of my completed Report via iReviewNow. Moreover, upon my approval via iReviewNow, I authorize QSI to transmit my report as may be required by various schools or potential employers seeking this information to make placement and/or hiring decision. I release and forever hold harmless QSI, SecurTest, Inc. and iReviewNow, LLC for releasing any or all of my background report or reports and my iReviewNow responses. QSI does not make hiring decisions or recommendations except for schools it manages or owns. All other employment or placement decisions are solely the responsibility of the employer. I also understand that if I do not review my Report via completion of the iReviewNow questionnaire, my report will not be transmitted to QSI.
I Agree*

I understand and agree to the statement above.

iReviewNow - Ensuring Accuracy and Fairness

INSTANT ABILITY TO REVIEW YOUR REPORT. Quality Schools International (hereafter "QSI") uses the exclusive patented iReviewNow software, which allows you to review your background (consumer) report to ensure that it is accurate.

How You Benefit:
- You have an opportunity to see the contents of your background report prior to, at the same time, or near the same time as the Company who you authorized to receive your report at iReviewNow.com or by email.
- You have an immediate opportunity to make sure the report is accurate, complete and up to date, and dispute any information you believe to be incomplete or inaccurate. You have an immediate opportunity to provide an explanation for any information contained in the report, especially information about your past, and provide any mitigating circumstances that may assist the Company receiving your background report with any decisions based upon your report.
I agree to the following terms and conditions.

1.       I certify that the information provided on the Background Information Form is my personal identifying information and is accurate and complete.

2.       I agree to review the consumer report about me for accuracy and completeness by exclusively using www.iReviewNow.com (hereafter “iReviewNow) as provided by iReviewNow, LLC. I agree to go to iReviewNow.com to view my report, answer the iReviewNow questions, and dispute any inaccurate or incomplete information.. I agree to contact SecurTest, Inc., the consumer reporting agency and background screening provider, at (800) 445-8001 if I am unable to view my report at iReviewNow.com or have any questions about my report.

3.       I agree and understand that iReviewNow, LLC is a software provider and is neither an employer nor a consumer reporting agency as defined by the Fair Credit Reporting Act. I understand that iReviewNow, LLC is solely providing software through which I may electronically access my report. I understand that the consumer reporting agency who prepared my report is SecurTest, Inc. I understand that iReviewNow nor the consumer reporting agency who procured my report, do not make any employment or other decisions for the Company receiving my report, and the employer is solely responsible for all employment decisions.

4.       By consenting to use iReviewNow, I authorize all legal notices to be provided to me electronically through iReviewNow.com, the email address I have provided understanding that standard text messaging rates apply, as I will receive text messages alerting me to go to iReviewNow.com when my report or notices are ready for my review.

5.       I understand that if I do not view and confirm or dispute my report within five business days from the first text, email message or notice that my report is completed and ready for my review, the Company authorized to review my report may consider a decision based on the contents of my consumer report.

6.       I agree to go to iReviewNow.com to register for automated notification of my report or to view the report when notified.

7.       I have had an opportunity to read or review the Summary of My Rights Under the FCRA and other state notices, other applicable regulations, state and federal laws and consult with legal counsel.

8.      ELECTRONIC SIGNATURE AUTHORIZATION: I hereby certify that if I elect to sign electronically that it may be used by the requesting agency, iReviewNow®, SecurTest®, Inc., and court researchers, investigators, or government entities to rely on it as if it were my original handwritten signature.

INVESTIGATIVE CONSUMER AGENCY CONDUCTING INVESTIGATION:

SecurTest, Inc. * 600 Grand Panama Blvd. Ste 202 * Panama City Beach, FL 32407 * (800) 445-8001 | www.securtest.com

iReviewNow® – © 2005-2019 – Patented Intellectual Property of Steven C. Millwee and SecurTest, Inc. - ALL RIGHTS RESERVED
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QSI Questionnaire
Answering “yes” to any of the following questions does not constitute an automatic bar to employment or placement. Factors such as date of the offense, seriousness and nature of the violation or matter, rehabilitation and position applied for will be considered. We are looking for reliable factual information. When answering the next set of questions, be sure to give accurate and truthful answers. If we discover that you have given inaccurate information or have lied, your contract with QSI may be in jeopardy. You must provide a detailed description to explain your answers where required.

We are aware there is no such thing as a PERFECT PERSON. We are looking for reliable factual information. When answering the next 10 questions, be sure to give accurate and truthful answers. If we discover that you have given inaccurate information or lied, you will not be hired or placed. Most of us have done something in our lives of which we are not very proud.

1. Has your professional license, certificate, permit, credential, endorsement, or registration ever been disciplined, suspended, revoked, reprimanded, restricted, curtailed or voluntarily surrendered?*

YesNoI'm not sure

1.A. You answered that your professional license, certificate, permit, credential, endorsement, or registration has been disciplined, suspended, revoked, reprimanded, restricted, curtailed or voluntarily surrendered. Explain in detail. Provides dates, locations, agencies, complaint details, and action taken.*

2. Do you have any pending complaints before any regulatory board or agency? .*

YesNoI'm not sure

2.A. You answered that you pending complaints before a regulatory board or agency. Explain in detail. *

3. Is there any investigation or adverse action now pending against you?*

YesNoI'm not sure

3.A. You answered there is a pending investigation or adverse action pending against you. Explain in detail. *

4. Have you ever been charged with, convicted or entered a plea, including a plea of nolo contendere (no contest or Alford plea), to any felony or misdemeanor whether or not sentence was imposed or suspended, except minor traffic violations? (We check your criminal history. Providing false or misleading information will result in denial of employment or placement as a teacher or loss of your position of retained.)*

YesNoI'm not sure

4.A. You answered that you been charged with, convicted or entered a plea, including a plea of nolo contendere (no contest or Alford plea), to a felony or misdemeanor whether or not sentence was imposed or suspended, except minor traffic violations. Explain in detail. Provide dates, locations (city, state country), law enforcement agency names, charges, and what happened in court.*

5. Have you ever resigned, been restricted, disciplined, or discharged from any position, including the armed forces, while under suspicion of having engaged in criminal, immoral, unethical behavior or unprofessional conduct?*

YesNoI'm not sure

5.A. You answered that you resigned, been restricted, disciplined, or discharged from any position, including the armed forces, while under suspicion of having engaged in criminal, immoral, unethical behavior or unprofessional conduct.Explain in detail, including the dates and what happened. *

6. Are you under investigation for of having engaged in criminal, immoral, unethical behavior or unprofessional conduct?*

YesNoI'm not sure

6.A. You answered that you are under investigation for of having engaged in criminal, immoral, unethical behavior or unprofessional conduct. Explain in detail, including the the dates, location (city, state) and what happened. *

7. Have you ever been denied a professional license, certificate, permit, credential, endorsement, or registration?*

YesNoI'm not sure

7.A. You answered that you have you been denied a professional license, certificate, permit, credential, endorsement, or registration. Explain in detail. *

8. Have you ever been the subject of a child protective order or investigation?*

YesNoI'm not sure

8A. You answered that you have you been the subject of a child protective order or investigation. Explain in detail, including the dates, and what happened. *

9. Have you ever been the subject of a temporary or permanent restraining order where you were requiring to stay away from a person or location?*

YesNoI'm not sure

9A. You answered that you have you been the subject of a temporary or permanent restraining order where you were required to stay away from a person or location.Explain in detail, including the dates, location (city, state) and what happened. *

10. When we search your social media post/profiles and do a search engine (Google) key word name search will we find any inappropriate pictures, culturally insensitive comments/posts, public comments that you made or forwarded that are not appropriate for professional educators to be posting on the internet?*

YesNoI'm not sure

10A. You answered that a search your social media post/profiles will find inappropriate pictures, culturally insensitive comments/posts, public comments you posted or forwarded that are not appropriate for professional educators. Explain in detail, including, the dates, what was posted, where it was posted, the reason for the post, and the dates of the post. *

11. When we search your social media posts and profiles, will we find any information that shows you are attracted to children, been accused of molesting a child or children, or been forced to resign a position over such allegations of sexual misconduct?*

YesNoI'm not sure

11.A You answered that when a search of your social media posts and profiles, it will information information that shows you are attracted to children, been accused of molesting a child or children, or been forced to resign a position over such allegations of sexual misconduct. Explain in detail, including the dates, locations, and what happened and what will be found.*

12. There is information on the Internet, reports, or records that claims I have been romantically or sexually involved with students or children under the age of 18.*

YesNoI'm not sure

12A. You answered there is information on the Internet, reports, or records that claims you have been romantically or sexually involved with students or children under the age of 18. Explain in detail, including dates and circumstances. *

13. Has any disciplinary action been taken against you due to behaviors that would not permit you to work in a school with teenagers and children such as, but not limited to, illegal or prescription drug abuse, alcohol use, sexual misconduct, being arrested or any other improper behavior?*

YesNoI'm not sure

13A. You answered that disciplinary action has been taken against you due to behaviors that would not permit you to work in a school with teenagers and children such as, but not limited to, illegal or prescription drug abuse, alcohol use, sexual misconduct, being arrested or any other improper behavior. Explain in detail, including the dates, the source of the information, and what happened. *

14. The background investigation will find that I have been accused of having sexual contact with a minor.*

YesNoI'm not sure

14A. You answered that the background investigation will find that you have been accused of having sexual contact with a minor. Explain in detail, including the dates, when, where, what was the allegation, and outcome. *

ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK

I acknowledge receipt of the separate document entitled DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by the (“Employer”) 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 SecurTest, Inc., 600 Grand Panama Blvd., Suite 202, Panama City Beach, FL 32407; tel. # 800.445.8001; www.securtest.com and/or Employer. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original.

New York applicants only: Upon request, you will be informed whether or not a consumer report was requested by the Employer, and if such report was requested, informed of the name and address of the consumer reporting agency that furnished the report. You have the right to inspect and receive a copy of any investigative consumer report requested by the Employer by contacting the consumer reporting agency identified above directly. By signing below, you acknowledge receipt of Article 23-A of the New York Correction Law.

New York City applicants only: You acknowledge and authorize the Employer to provide any notices required by federal, state or local law to you at the address(es) and/or email address(es) you provided to the Employer.

Washington State applicants only: You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act.
Minnesota and Oklahoma applicants only: Please check this box if you would like to receive a copy of a consumer report if one is obtained by the Employer.

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By clicking submit I agree to all terms and conditions set forth herein.

I certify under penalty of perjury that my answers to questions were truthful.

My electronic signature shall be the same as a handwritten signature, and shall be used as evidence that each form as required by law as been received and reviewed by me, as I reviewed each form when completing this request. I further acknowledge that all legal notices required by law or regulations were provided to me, which can be reviewed at https://www.securtest.com/SecurTestNotices.pdf and are an official part of my consent and authorization for SecurTest and the Employer, Entity, or User to perform the background investigaiton. These notices and forms were on stand-a-lone screens or pages as seen the PDF version referenced herein.

DO NOT CLOSE THIS WINDOW OR GO TO ANOTHER APPLICATION AFTER CLICKING SUBMIT UNTIL THE THANK YOU PAGE APPEARS, AS IT MAY TAKE A MINUTE OR TWO TO UPLOAD YOUR INFORMATION.
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PLEASE BE PATIENT.....DO NOT CLOSE THIS WINDOW OR GO TO ANOTHER APPLICATION AFTER CLICKING SUBMIT UNTIL THE THANK YOU PAGE APPEARS, AS IT MAY TAKE A MINUTE OR TWO TO UPLOAD YOUR INFORMATION.
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