We cannot complete the background check without a perssonal email address, copy of driver's license, copy of social security card, as this is needed to send the background permission request.

Once we have received the signed Contractors packet and your personal email address, we will initiate the Background Check. You will receive an email stating, "Corecivic has invited you". This is so that you can create an account and complete the required Information. The link in the upcoming email will expire 10 days from the date of the email sent. If Candidates do not see an email from CoreCivic  in their inbox, please have them check their spam.

If you do not see the email in your inbox, please check your spam folder. Please reach out should you run into any issues or have questions to either my direct number (775) 751-4516 or respond via email Maryjo.Kullmann@CoreCivic.com

U.S. Department of Justice United States Marshals Service

Please type or print and complete all items.

I certify, that the statements made by me on this form are true, complete, and correct to the best of my knowledge and belief, and are trade in good faith. I understand that this Information may be used for a records check done by the Federal Bureau of Investigation.

Background Investigation Disclosure and Authorization Form

IMPORTANT - PLEASE READ CAREFULLY BEFORE SIGNING AUTHORIZATION

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

CoreCivic may obtain information about you for employment purposes from a third party consumer reporting agency. Thus, you may be the subject of a "consumer report" and/or an "investigative consumer report" which may include Information about your character, general reputation, personal characteristics, and/or mode of living, and which can Involve personal Interviews with sources such as your neighbors, friends, or associates. These reports may contain Information regarding your credit history, criminal history, social security verification, motor vehicle records ("driving records"), verification of your education or employment history, or other background checks. Credit history will only be requested where such information is related to the dutles and responsibilities of the position for which you are applying. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report and a copy of any report about you. Please be advised that the nature and scope of the most common form of Investigative consumer report obtained with regard to applicants for employment is an Investigation into your education and/or employment history conducted by First Advantage Background Services Corp. ("First Advantage"), P.O. Box 105292, Atlanta, GA 30348, 1-800-845-6004. The scope of this notice and authorization Is all-encompassing, however, allowing CoreCivic to obtain from any outside organization all manner of consumer reports and investigative consumer reports now and throughout the course of your employment to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report.

ACKNOWLEDGMENT AND AUTHORIZATION

I acknowledge receipt of the 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 authorize CoreCivic to make whatever inquiries it may deem necessary in connection with my application(s) to and/or my employment with CoreClvic. CoreCivic has my permission to contact persons who might have Information relating to my suitability for employment and to secure consumer reports (Including consumer credit reports and investigative consumer reports). I understand that information obtained by CoreCivic in accordance with this authorization may include Information pertaining to my character, general reputation, personal characteristics, work habits, mode of living, driving record, judgments, liens, arrests and convictions. This authorization shall remain in effect (for external applicants) for NINETY DAYS or (for internal applicants) ONE YEAR from the date of my signature on this authorization.

I authorize, without reservation, any party or agency contacted by CoreCivic to furnish the above information. I further authorize CoreCivic to furnish copies of this authorization and my application to any person(s) and/or consumer reporting agency(ies) in connection with the above purposes. I agree that a facsimile ("fax"), electronic or photographic copy of this Authorization shall be as valid as the original.

CALIFORNIA applicants or employees only: By signing below, you acknowledge receipt of the NOTICE - BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check the box If you would like to receive a copy of the investigative consumer report or consumer credit report, free of charge, if one Is obtained by us. Check box to receive report: NEW YORK applicants or employees only: You have the right to Inspect and receive a copy of any Investigative consumer report requested by us by contacting First Advantage, P.O. Box 105292, Atlanta, GA 30348, 1-800- 845-6004.

NEW YORK applicants or employees only: By signing below, you acknowledge receipt of a copy of Article 23- A of the New York Correction Law.

WASHINGTON applicants or employees only: You have the right to request from First Advantage, P.O. Box 105292, Atlanta, GA 30348, 1-800-845-6004, a written summary of your rights and remedies under the Washington Fair Credit Reporting Act. MASSACHUSETTS, MINNESOTA and OKLAHOMA applicants or employees only: Please check the box If you would like to receive a copy of your consumer report, free of charge, if one is obtained by us. Check box to receive report:

AUTHORIZATION FOR RELEASE OF INFORMATION CRIMINAL HISTORY CHECK

I hereby authorize a representative of the Federal Bureau of Prisons to obtain information on my criminal history background. I understand that this check must be done before I am allowed to enter/serve at any Bureau facility. I also understand that refusal to provide all necessary Information may result in (1) denial of entry into a Bureau facility and (2) denial of volunteer/contract status.

Authority for Collecting Information: E.O. 10450; 5 USC 1303-1305; 42 USC 2165 and 2455; 22 USC 2585 and 2519; and 5 USC 3301

Purposes and Uses: Information provided on this form will be furnished to individuals In order to obtain Information regarding activities in connection with an Investigation to determine (1) fitness for Federal employment, (2) clearance to perform contractual service for the Federal Government, (3) security clearance or access. The information obtained may be furnished to third partles as necessary In the fulfillment of official responsibilities. Effects of Non-Disclosures: Furnishing the requested Information is voluntary, but failure to provide all or of part the Information may result in lack of further consideration for employment, clearance or access, or in the termination of your employment.

In accordance with 18 USCA $ 921 and 922 (1996), "it is unlawful for any person who has been convicted In any court of a misdemeanor crime of domestic violence to possess a firearm." For Purposes of employment with CoreCivic, an individual convicted of a misdemeanor crime of domestic violence as defined below cannot carry a firearm In the course of his/her employment.

"Misdemeanor crime of domestic violence means an offense that -

1. Is a misdemeanor under Federal or State law; and
2. Has, as an element, the use or attempted use of physical force, or the threatened use of a deadly weapon, committed by a current or former spouse, parent or guardian of the victim, by a person with whom the victim shares a child In common, by a person who Is cohabitating with or has cohabitated with the victim as a spouse, parent or guardian or by a person similarly situated or a spouse, parent or guardian of the victim.
3. A person shall not be considered to have been convicted of such an offense for purposes of this chapter, unless:
   1. The person was represented by counsel In the case, or knowingly and Intelligently walved the right to counsel in the case; and 
   2. In the case of a prosecution for an offense described herein for which a person was entitled to a Jury trial In the Jurisdiction In which the case was tried, elther:
      1. The case was tried by a Jury, or
      2. The person knowingly and Intelligently walved the right to have a case tried by a Jury, by guilty plea or otherwise.
   3. A person shall not be considered to have been convicted of such an offense for purposes of herein If the convicted has been expunged or set aside, or is an offense for which the person has been pardoned or has had civil rights restored (If the law of the applicable jurisdiction provides for the loss of civil rights under such an offense) unless the pardon, expungement or restoration of civil rights expressly provides that the person may not ship, transport, possess or receive flrearms."

I hereby certify that, to the best of my knowledge and belief, all of the Information I provide In this form is true, complete and made In good faith. I understand that false and fraudulent Information provided herein may disqualify me from further consideration for employment and If employed, may result In termination of employment If discovered at a later date. 

By signing below, you certify that, to the best of your knowledge and belief, the information you provide on this form is true, complete, and made in good faith. You certify your understanding that If you provide false or fraudulent information you could be disqualified from further consideration for employment or, if falsity is discovered after you have become employed, terminated from employment.

42 U.S. Code § 1997 The term "Institution" means any facility or Institution - -

1. which is owned, operated, or managed by, or provides services on behalf of any State or political subdivision of a State; and
2. which is -
   1. for persons who are mentally ill, disabled, or retarded, or chronically ill or handicapped;
   2. a Jall, prison, or other correctional facility;
   3. a pretrial detention facility;
   4. for Juveniles -
      1. held awaiting trial;
      2. residing in such facility or institution for purposes of receiving care or treatment; or
      3. residing for any State purpose In such facility or institution (other than a residential facility providing only elementary or secondary education that is not an institution In which reside juveniles who are adjudicated delinquent, in need of supervision, neglected, placed in State custody, mentally ill or disabled, mentally retarded, or chronically III or handicapped); or
   5. providing skilled nursing, Intermediate or long-term care, or custodial or residential care.

By my signature below, I understand my continuing affirmative duty to disclose any facts that would change my answers above. I further understand that any material omissions regarding such misconduct, or the provision of materially false information, Is grounds for termination or refusal to hire.