DISCLOSURE AND AUTHORIZATION REGARDING BACKGROUND
DISCLOSURE AND AUTHORIZATION REGARDING BACKGROUND
DAC EMPLOYMENT HISTORY FILE
DISCLOSURE
Z Transportation Inc. (the “Company”) may request from a consumer reporting agency and for employment-related purposes, a “consumer report(s)” (commonly known as “background reports”) containing background information about you in connection with your employment, or application for employment, or engagement for services (including independent contractor or volunteer assignments, as applicable). HireRight, LLC (“HireRight”) will prepare or assemble the background reports for the Company. HireRight is located and can be contacted at 3349 Michelson Drive, Suite 150, Irvine, CA 92612, (800) 400-2761, www.hireright.com. The background report(s) may contain information concerning your character, general reputation, personal characteristics, mode of living, or credit standing. The types of background information that may be obtained include, but are not limited to: criminal history; litigation history; motor vehicle record and accident history; social security number verification; address and alias history; credit history; verification of your education, employment and earnings history; professional licensing, credential and certification checks; drug/alcohol testing results and history; military service; and other information.
AUTHORIZATION
I hereby authorize Company to obtain the consumer reports described above about me.
Applicant Name
Date
/
MM
/
DD
YYYY
Your Signature
*
Clear
[END OF DOCUMENT] PLEASE PROCEED TO THE NEXT DOCUMENT ENTITLED: “OTHER DISCLOSURES, ACKNOWLEDGMENTS & AUTHORIZATIONS REGARDING BACKGROUND INVESTIGATION FOR EMPLOYMENT PURPOSES”
OTHER DISCLOSURES, ACKNOWLEDGMENTS & AUTHORIZATIONS REGARDING BACKGROUND INVESTIGATION FOR EMPLOYMENT PURPOSES
Disclosures
Investigative Consumer Report: __Z Transportation Inc._ (the “Company”) may request an investigative consumer report about you from HireRight, LLC (“HireRight”), a consumer reporting agency, in connection with your employment, or application for employment, or engagement for services (including independent contractor or volunteer assignments, as applicable). 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 information obtained from personal interviews), the most common form of which is checking personal or professional references through personal interviews with sources such as your former employers and associates, and other information sources. The investigative consumer report may contain information concerning your character, general reputation, personal characteristics, mode of living, or credit standing. You may request more information about the nature and scope of an investigative consumer report, if any, by contacting the Company.
Ongoing Authorization: If the Company hires you or contracts for your services, the Company may obtain additional consumer reports and investigative consumer reports about you without asking for your authorization again, throughout your employment or your contract period, as allowed by law.
Additional State Law Notices: Please see the “Additional State Law Notices” for California, Massachusetts, Minnesota, New Jersey, New York, and Washington that are provided below, as applicable. A California disclosure and summary of your rights under California Civil Code Section 1786.22, and a copy of New York Article 23-A, are being provided to you separately.
Summary of Rights under the Fair Credit Reporting Act: A summary of your rights under the Fair Credit Reporting Act is being provided to you separately.
San Francisco Fair Chance Ordinance Official Notice: A copy of the San Francisco Fair Chance Ordinance Official Notice is being provided to you separately. HireRight Privacy Policy: Information about HireRight’s privacy practices is available at www.hireright.com/Privacy-Policy.aspx.
ACKNOWLEDGMENTS & AUTHORIZATION
I acknowledge that I have received and carefully read and understand the separate “Disclosure and Authorization Regarding Background Investigation for Employment Purposes”; and the separate “Summary of Rights under the Fair Credit Reporting Act” that have been provided to me by the Company. I also acknowledge receipt of and that I have carefully read and understand (as applicable), the separate California Disclosure and Summary of Rights under California Civil Code Section 1786.22; the separate New York Article 23-A; and the separate San Francisco Fair Chance Ordinance Official Notice that have been provided to me. By my signature below, I authorize the preparation of background reports about me, including background reports that are “investigative consumer reports” by HireRight, and to the furnishing of such background reports to the Company and its designated representatives and agents, for the purpose of assisting the Company in making a determination as to my eligibility for employment or engagement for services (including independent contractor or volunteer assignments, as applicable), promotion, retention or for other lawful employment purposes. I understand that if the Company hires me or contracts for my services, my consent will apply, and the Company may, as allowed by law, obtain from HireRight (or from a consumer reporting agency other than HireRight) additional background reports pertaining to me, without asking for my authorization again, throughout my employment or contract period. I understand that if the Company obtains a credit report about me, then it will only do so where such information is substantially related to the duties and responsibilities of the position in which I am engaged or for which I am being evaluated. I understand that information contained in my employment (or contractor or volunteer) application, or otherwise disclosed by me before or during my employment (or contract or volunteer assignment), if any, may be used for the purpose of obtaining and evaluating background reports on me. I also understand that nothing herein shall be construed as an offer of employment or contract for services. I understand that the information included in the background reports may be obtained from private and public record sources, including without limitation and as appropriate: government agencies and courthouses; educational institutions; and employers. Accordingly, I hereby authorize all of the following, to disclose information about me to the consumer reporting agency and its agents: law enforcement and all other federal, state and local government agencies and courts; educational institutions (public or private); testing agencies; information service bureaus; credit bureaus and other consumer reporting agencies; other public and private record/data repositories; motor vehicle records agencies; my employers; the military; and all other individuals and sources with any information about or concerning me. The information that can be disclosed to the consumer reporting agency and its agents includes, but is not limited to, information concerning my: employment and earnings history; education, credit, motor vehicle and accident history; drug/alcohol testing results and history; criminal history; litigation history; military service; professional licenses, credentials and certifications; social security number verification; address and alias history; and other information. By my signature below, I also promise that the personal information I provide with this form or otherwise in connection with my background investigation is true, accurate and complete, and I understand that dishonesty or material omission may disqualify me from consideration for employment. I agree that a copy of this document in faxed, photocopied or electronic (including electronically signed) form will be valid like the signed original. I further acknowledge that I have received additional state law notices that I have reviewed and read.
California, Minnesota or Oklahoma consumers: Please check this box if you would like to receive(whenever you have such right under the applicable state law) a free copy of your background report if one isobtained on you by the Company.
ADDITIONAL STATE LAW NOTICES
Please also note the following
CALIFORNIA: Pursuant to section 1786.22 of the California Civil Code, you may view the file maintained on you by the consumer reporting agency during normal business hours. You may also obtain a copy of this file, upon submitting proper identification and paying the actual copying costs, by appearing at the consumer reporting agency’s offices in person, during normal business hours and on reasonable notice, or by certified mail. You may also receive a summary of the file by telephone, upon submitting proper identification and written request. The consumer reporting agency has trained personnel available to explain your file to you, including any coded information, and will provide a written explanation of any coded information contained in your file. If you appear in person, you may be accompanied by one other person, provided that person furnishes proper identification. “Proper identification” includes documents such as a valid driver’s license, social security account number, military identification card, and credit cards. If you cannot identify yourself with such information, the consumer reporting agency may require additional information concerning your employment and personal or family history to verify your identity. HireRight, LLC (“HireRight”) will prepare the background report for the Company. HireRight is located and can be contacted at 3349 Michelson Drive, Suite 150, Irvine, CA 92612, (800) 400-2761. Information about HireRight’s privacy practices is available at www.hireright.com/Privacy-Policy.aspx. Additional California-specific information is set out below.
MASSACHUSETTS: Upon request to the Company, you have the right to know whether the Company requested an investigative consumer report about you and, upon written request to the Company, you have the right to receive a copy of any such report. You also have the right to ask the consumer reporting agency (e.g., HireRight) for a copy of any such report.
MINNESOTA: You have the right in most circumstances to submit a written request to the consumer reporting agency (e.g., HireRight) for a complete and accurate disclosure of the nature and scope of any consumer report the Company ordered about you. The consumer reporting agency must provide you with this disclosure within 5 days after (i) its receipt of your request or (ii) the date the report was requested by the Company, whichever date is later.
NEW JERSEY: You have the right to submit a request to the consumer reporting agency (e.g., HireRight) for a copy of any investigative consumer report the Company requested about you.
NEW YORK: You have the right, upon written request to the Company, to be informed of whether or not the Company requested a consumer report or an investigative consumer report about you. Shown above is the address and telephone number for HireRight, the consumer reporting agency used by the Company. You may inspect and receive a copy of any such report by contacting that consumer reporting agency. A copy of Article 23-A of the New York Correction Law is also provided below.
WASHINGTON STATE: If the Company requests an investigative consumer report, you have the right, upon written request made to the Company within a reasonable period of time after your receipt of this disclosure, to receive from the Company a complete and accurate disclosure of the nature and scope of the investigation requested by the Company. You are entitled to this disclosure within 5 days after the date your request is received or the Company ordered the report, whichever is later. You also have the right to request a written summary of your rights and remedies under the Washington Fair Credit Reporting Act.
Applicant Name
First
Last
Date
/
MM
/
DD
YYYY
Your Signature
*
Clear
Para información en español, visite www.consumerfinance.gov/learnmore o escribe a la Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.
A Summary of Your Rights Under the Fair Credit Reporting Act
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 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 20552.
You must be told if information in your file has been used against you. Anyone who uses a creditreport 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 informationabout you in the files of a consumer reporting agency (your “file disclosure”). You will be required toprovide proper identification, which may include your Social Security number. In many cases, thedisclosure 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 identity 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 consumerreporting agencies that create scores or distribute scores used in residential real property loans, but youwill have to pay for it. In some mortgage transactions, you will receive credit score information for freefrom the mortgage lender.
You have the right to dispute incomplete or inaccurate information. If you identify information inyour file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. Seewww.consumerfinance.gov/learnmore for an explanation of dispute procedures.
Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiableinformation. Inaccurate, incomplete, or unverifiable information must be removed or corrected,usually within 30 days. However, a consumer reporting agency may continue to report information ithas verified as accurate.
Consumer reporting agencies may not report outdated negative information. In most cases, aconsumer reporting agency may not report negative information that is more than seven years old, orbankruptcies that are more than 10 years old.
Access to your file is limited. A consumer reporting agency may provide information about you onlyto 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 agencymay not give out information about you to your employer, or a potential employer, without your writtenconsent given to the employer. Written consent generally is not required in the trucking industry. Formore information, go to www.consumerfinance.gov/learnmore.
You may limit “prescreened” offers of credit and insurance you get based on information in yourcredit report. Unsolicited “prescreened” offers for credit and insurance must include a toll-free phonenumber you can call if you choose to remove your name and address form the lists these offers arebased on. You may opt out with the nationwide credit bureaus at 1-888-5-OPTOUT (1-888-567-8688).
The following FCRA right applies with respect to nationwide consumer reporting agencies:
CONSUMERS HAVE THE RIGHT TO OBTAIN A SECURITY FREEZE You have a right to place a “security freeze” on your credit report, which will prohibit aconsumer reporting agency from releasing information in your credit report without your expressauthorization. The security freeze is designed to prevent credit, loans, and services from beingapproved in your name without your consent. However, you should be aware that using a securityfreeze to take control over who gets access to the personal and financial information in your creditreport may delay, interfere with, or prohibit the timely approval of any subsequent request or applicationyou 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.
You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user ofconsumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, youmay be able to sue in state or federal court.
Identity theft victims and active duty military personnel have additional rights. For moreinformation, visit www.consumerfinance.gov/learnmore.
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:
TABLE PICTURE
(CALIFORNIA APPLICANTS ONLY) CALIFORNIA DISCLOSURE
The Company may order an investigative consumer report on you in connection with your employment application, and if you are hired, or if you already work for the Company, the Company may order additional such reports on you for employment purposes. Such reports may contain information about your character, general reputation, personal characteristics, and mode of living. The types of background information that may be obtained include, but are not limited to: criminal history; litigation history; motor vehicle record and accident history; social security number verification; address and alias history; credit history; verification of your education, employment and earnings history; professional licensing, credential and certification checks; drug/alcohol testing results and history; military service; and other information. The investigative consumer reporting agency, HireRight, LLC (“HireRight”), will prepare the background report for the Company. HireRight is located and can be contacted at 3349 Michelson Drive, Suite 150, Irvine, CA 92612, (800) 400-2761, www.hireright.com. Information about HireRight’s privacy practices is available at www.hireright.com/Privacy-Policy.aspx.
A SUMMARY OF YOUR RIGHTS UNDER CALIFORNIA CIVIL CODE SECTION 1786.22
(a)An investigative consumer reporting agency shall supply files and information required under Section1786.10 during normal business hours and on reasonable notice. (b)Files maintained on a consumer shall be made available for the consumer’s visual inspection, as follows: (1)In person, if he appears in person and furnishes proper identification. A copy of his file shall also beavailable to the consumer for a fee not to exceed the actual costs of duplication services provided. (2)By certified mail, if he makes a written request, with proper identification, for copies to be sent to aspecified addressee. Investigative consumer reporting agencies complying with requests for certifiedmailings under this section shall not be liable for disclosures to third parties caused by mishandling ofmail after such mailings leave the investigative consumer reporting agencies. (3)A summary of all information contained in files on a consumer and required to be provided by Section 1786.10 shall be provided by telephone, if the consumer has 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 the consumer. (c)The term “proper identification” as used in subdivision (b) shall mean that information generally deemedsufficient to identify a person. Such information includes documents such as a valid driver’s license, socialsecurity account number, military identification card, and credit cards. Only if the consumer is unable toreasonably identify himself with the information described above, may an investigative consumer reportingagency require additional information concerning the consumer’s employment and personal or family history inorder to verify his identity. (d)The investigative consumer reporting agency shall provide trained personnel to explain to the consumer anyinformation furnished him pursuant to Section 1786.10. (e)The investigative consumer reporting agency shall provide a written explanation of any coded informationcontained in files maintained on a consumer. This written explanation shall be distributed whenever a file isprovided to a consumer for visual inspection as required under Section 1786.22. (f)The consumer shall be permitted to be accompanied by one other person of his choosing, who shall furnishreasonable identification. An investigative consumer reporting agency may require the consumer to furnish awritten statement granting permission to the consumer reporting agency to discuss the consumer’s file in suchperson’s presence.
(NEW YORK APPLICANTS ONLY) 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 associationwhich employs ten or more persons. (3)"Direct relationship" means that the nature of criminal conduct for which the person was convictedhas 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 thisstate, 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 oreducational 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 oremployment at any public or private employer, who has previously been convicted of one or more criminaloffenses in this state or in any other jurisdiction, and to any license or employment held by any person whoseconviction of one or more criminal offenses in this state or in any other jurisdiction preceded such employmentor 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 goodconduct. Nothing in this article shall be construed to affect any right an employer may have with respect to anintentional misrepresentation in connection with an application for employment made by a prospectiveemployee 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 theprovisions 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 specificlicense 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 wouldinvolve 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 publicagency 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 employmentof persons previously convicted of one or more criminal offenses. (b)The specific duties and responsibilities necessarily related to the license or employment sought orheld by the person. (c)The bearing, if any, the criminal offense or offenses for which the person was previously convictedwill 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 rehabilitationand good conduct. (h)The legitimate interest of the public agency or private employer in protecting property, and thesafety 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 publicagency 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 previouslyconvicted of one or more criminal offenses who has been denied a license or employment, a public agency orprivate employer shall provide, within thirty days of a request, a written statement setting forth the reasons forsuch denial. §755. Enforcement. 1.In relation to actions by public agencies, the provisions of this article shall be enforceable by aproceeding 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 thedivision 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.
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.
