The Employer, ENCORE PIPE & CONSTRUCTION, LLC may obtain information about you for
employment purposes from a third party consumer reporting agency. Thus, you maybe 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, supervisors, 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. Further, you understand that informaUon
may be requested from various Federal, State, County and other agencies that maintain records
concerning your past activities relating to your driving, criminal, civil, education, credit, and
other experiences. Credit history will only be requested where such information is substantially
related to the duties and responsibilities of the position for which you are applying.
You have the right, upon written request made within a reasonable period of time after receipt of
this notice, to request whether a consumer report has been conducted about you, disclosure of the
nature and scope of any investigative consumer report, and to request a copy of your report. 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 employment and/or
education history. The scope of this notice and authorization is all-encompassing, however, allowing
the Company to obtain consumer reports and investigative consumer reports now and throughout the
course of your employment to the extent permitted by law, unless you otherwise revoke your consent
by providing written notification to Company. As a result, you should carefully consider whether to
exercise your right to request disclosure of the nature and scope of any investigative consumer
The consumer and/or investigative consumer report(s) will be obtained from:
Accurate Background, Inc., 7515 Irvine CenterDrive, Irvine, CA 92618, (800) 2164024.
California applicants or employees only: By signing below, you also acknowledge receipt of A SUMMARY
OF YOUR RIGHTS UNDER THE PROVISIONS OF CALIFORNIA CIVIL ODES1786.22.
Please check the appropriate box below if you would like to receive a copy of your investigative
consumer or consumer credit report at no charge.
Minnesota and Oklahoma applicants or employees only: Please check the appropriate box below if you
would like to receive a copy of your consumer report free of charge.
New York and Maine applicants or employees only: You have the right to inspect and receive a copy of
any Investigative consumer report requested by Company by contacting the consumer reporting agency
identified above directly. You may also contact the Company to request the name, address and
telephone number of the nearest unit of the consumer reporting agency designated to handle Inquiries,
which the Company shall provide within 5 days.
New York applicants or employees only: Upon request you will be informed whether or not a consumer
report was requested by Company, and if such report was requested, informed of the name and address
of the consumer reporting agency that furnished the report By signing the authorization, you also
acknowledge receipt of Article 23-A of the New York Correction Law.
Oregon applicants or employees only: Information describing your rights under federal and Oregon law
regarding consumer identity theft protection, the storage and disposal of your credit Information,
and remedies available should you suspect or find that the Company has not maintained secured
records is available to you upon request.
Washington State applicants or empoyees 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
ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK
I acknowledge receipt of the DISCLOSURE REGARDING CONSUMER AND/OR INVESTIGATIVE REPORT 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 thereby authorize the obtaining of "consumer reports" and/or investigative
consumer reports by the Company 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, local, 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 Accurate Background, Inc., 7515 Irvine Center Drive, Irvine, CA
92618 (800) 2164024, www.accuratebackground.com, another outside organization acting on behalf of
the Company, and/or the Company itself.
I understand that by signing my name below, that lam signing the Authorization form directing the
background check as described above, and I certify that:
I have received the Disclosure Regarding Consumer and/or Investigative Report, have read and received
the Summary of Your Rights, and if a California resident/applicant, the A Summary of Your Rights
Under the Provisions of California Civil Code §1786.22.
I understand that my signature now and throughout this process will be binding. Additionally,
notices, documents, and communications maybe provided electronically and will meet the requirements
set forth underFederal and/or State law, as permitted by law. I agree that a facsimile ('fax"),
electronic or printout of this authorization may be accepted with the same authority as the
For California, Oklahoma, or Minnesota employees and applicants: Please check the appropriate box to
indicate if you would like to receive a copy of your consumer report free of charge.
For this online application, there will be no consumer report generated until you've been contacted
by the employment office about the position you are applying for. At that time, you may sign the
form mentioned above before any report is generated.