(ACKNOWLEDGMENT AND AUTHORIZATION -
[IMPORTANT -- PLEASE READ CAREFULLY BEFORE SIGNING]
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 received and read both documents. I hereby authorize procurement of "consumer reports" and/or "investigative consumer reports" at any time after receipt of this authorization and, if I am hired (including contract and volunteer services), throughout my employment (contract and volunteer services), as allowed by law. To this end, I hereby authorize, as allowed by law, 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 Hire Image LLC, 6 Alcazar Ave., Johnston, RI 02919, www.hireimage.com, tel. 1-888-433-0090, fax 866-494- 7191, another outside organization acting on behalf of the Company, and/or the Company itself. I authorize these agencies to provide you with consumer and investigative consumer reports. I agree that a facsimile ("fax"), electronic or photographic copy of this Acknowledgment and Authorization shall be as valid as the original.
I understand that if driving a company vehicle (or my own vehicle, as required) is a requirement of the position I am being considered for, then having and maintaining a satisfactory driving record and being able to legally and safely drive is required for my employment. If applicable, I agree to allow the Company to check my driving record, which contains personal information and may contain information about my physical, mental, or behavioral health maintained by a state government agency that has restricted my ability to drive legally, prior to hire and periodically thereafter. A driving record may also be obtained to verify my identity.
I understand that if drug and/or alcohol testing is requested, I authorize collection site personnel, medical review officer or employer representative to obtain the information necessary to comply applicable laws and with the Company's drug and alcohol policy. I acknowledge that I have been provided the employer's drug and alcohol testing (substance abuse) policy, if applicable.
The scope of this authorization will allow the Company to obtain from any outside organization all manner of consumer reports and investigative consumer reports now and, if I am hired (including contract or volunteer services), throughout the course of my employment (including contract or volunteer services), to the extent permitted by law. As a result, I should carefully consider whether to exercise my right to request disclosure of the nature and scope of any investigative consumer report. Hire Image's Privacy Policy can be found at www.hireimage.com.
I understand that I have the following rights in connection with this authorization: You have the right, upon written request made, within a reasonable time after receipt of this notice, to ask the Company to disclose the nature and scope of any consumer report. You may also request a copy of that report from the Company. You also may request a copy of that report from Hire Image LLC. If anyone other than Hire Image LLC furnishes an investigative consumer report, the Company will provide relevant contact information within five business days of your request. An "investigative consumer report" is a background report that includes information from personal interviews (except in California, where that term includes background reports with or without personal interviews). Please be advised that the nature and scope of the most common, but not exclusive, form of investigative consumer report obtained with regard to applicants for employment is an investigation into your education and/or employment history conducted by Hire Image LLC via interviews with past employers, neighbors, friends, or associates.
I understand that by signing and dating below:
- I authorize the Company to procure the consumer report(s) described above (including driving records, if applicable, or substance abuse testing, if permitted by law) from or through Hire Image LLC;
- To the extent applicable, I authorize the Company to share reports with third party companies for whom I may be placed to perform services;
- I consent to transacting electronically, including receiving legally required notices electronically;
- I have received and read the Disclosure Regarding Background Investigation;
- I have received and read the State/County/City Specific Rights of Applicants or Employees Regarding Background Investigation;
- have read the Acknowledgment and Authorization above.