APPLICANT DISCLOSURE STATEMENT
In connection with your application with DG Construction & Hauling, LLC and any subsidiary, you may have information requested about you from a consumer reporting agency for “employment purposes” as such term is used within The Fair Credit Reporting Act 15 U.S.C. § 1681. This information may be obtained in the form of consumer reports and/or investigative consumer reports.
These reports may contain information about your character, general reputation, personal characteristics and/or mode of living. The types of information that may be obtained include, but are not limited to: social security number verifications; address history; criminal records checks; public court records checks; driving records checks; employment history verifications; and professional licensing/certification checks. This information may be obtained from private and/or public records sources, including, as appropriate, governmental agencies and courthouses; educational institutions; former employers; or other information sources.
If adverse action is taken from information obtained, in whole or in part, from a consumer report and/or investigative consumer report from a consumer reporting agency, you have the right to receive a copy of the report(s) from the consumer reporting agency. The consumer reporting agency which prepared the consumer report and/or investigative consumer report was Aegis Alliance, LLC. Aegis Alliance, LLC can be contacted at 185 S. Beadle Road, Bldg. 2B, Lafayette, LA 70508 or by phone at (337)484-1466 or by email at support@aegisally.com.
[End of Disclosure Statement]
Aegis Alliance, LLC- CONFIDENTIAL
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Authorization of Background Investigation
I have carefully read, and understand, this Authorization form and further acknowledge receipt of the separate document entitled “A Summary of Your Rights under the Fair Credit Reporting Act” (available at http://www.aegisally.com/compliance.php or as a hard copy provided by the DG CONSTRUCTION & HAULING, LLC) and the “Applicant Disclosure Statement” and certify that I have read and understand both documents. By my signature below, I consent to the release of consumer reports and/or investigative consumer reports (“Background Reports”) prepared by a consumer reporting agency, such as Aegis Alliance, LLC., to DG CONSTRUCTION & HAULING, LLC and its designated representatives and agents for the purpose of determining my eligibility for employment, continuing employment, employment retention, promotion, reassignment, volunteering, as an independent contractor for services with the DG CONSTRUCTION & HAULING, LLC, or other lawful purposes.
I understand that if DG CONSTRUCTION & HAULING, LLC engages in a relationship with me, my consent will apply, and DG CONSTRUCTION & HAULING, LLC may obtain Background Reports throughout my relationship with them, if such obtainment is permissible under applicable State law and DG CONSTRUCTION & HAULING, LLC policy. I also understand that information contained in my application, or otherwise disclosed by me may be used when ordering the Background Reports and that nothing herein shall be construed as an offer of employment or a guarantee of a relationship with DG CONSTRUCTION & HAULING, LLC.
I hereby authorize law enforcement agencies, educational institutions (including public and private schools/universities), information service bureaus, consumer reporting agencies, record/data repositories, courts (federal, state, and local), motor vehicle records agencies, my past or present employers, the military, and other information sources to furnish any, and all, information on me that is requested by the consumer reporting agency.
California Applicants Only: I acknowledge receipt of a copy of California Civil Code 1786.22. Pursuant to Section 1786.22 of the California Civil Code, you may view the file maintained on you by S2Verify during normal business hours. You may also obtain a copy of this file, upon submitting proper identification by appearing at S2Verify's offices in person, during normal business hours and on reasonable notice, or by mail. You may also receive a summary of the file by telephone, upon submitting proper identification. S2Verify has trained personnel available to explain your file to you, including any coded information.
By signing below, you acknowledge receipt of California Civil Code 1786.22, available at http://www.aegisally.com/compliance.php.
New York Applicants Only: I acknowledge receipt of a copy of Article 23-A of New York Correction Law.
By signing below, you acknowledge receipt of Article 23-A of the New York Correction Law, available at http://www.aegisally.com/compliance.php.
By my signature below, I certify the information I provided on, and in connection with, this form is true, accurate, and complete. I agree that this Authorization form in original, facsimile, photocopy, or electronic (including electronically signed) formats, will be valid for any reports that may be requested by, or on behalf of, DG CONSTRUCTION & HAULING, LLC.