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NOTICE TO APPLICANT AND AUTHORIZATION FORM

An investigative consumer report will be obtained on you by the Company, through Sierra HR Partners, Inc., as part of the employment application process. You must authorize the Company and Sierra HR Partners, Inc. to obtain this information. Please review this document and the separate Disclosure. If you agree, please sign and date below.

Sierra HR Partners, Inc. will conduct a pre-employment background investigation. Sierra HR Partners, Inc. may request and receive reports, records and/or information from former employers, personal references, government agencies, licensing entities, state and federal courts, or educational institutions. An investigative consumer report may include information about your credit worthiness, credit standing, credit capacity (based on the position requirements in keeping with state law), character, general reputation, personal characteristics or mode of living.

You may receive a free copy of the investigative consumer report within three days of the time the report is released to the Company, along with a copy of “A Summary of Your Rights under the Fair Credit Reporting Act”. The Company will notify you if adverse action is taken against you based upon the contents, either in whole or in part, of the report, along with a copy of the report. You have the right to dispute the findings contained in the report with Sierra HR Partners, Inc., if the dispute is made in writing within 60 days of the date of adverse action.

Upon written request, Sierra HR Partners, Inc. will disclose to you the nature and scope of the investigation requested. You may also request all of the information contained in your file; the sources of information; the identity of each person who procured your report within three years; the dates, original payees and amounts of any checks upon which is based any adverse characterization; and a record of all inquiries received by Sierra HR Partners, Inc. within the past year that identified you in connection with a credit or insurance transaction that you did not initiate.

You may inspect your file during normal business hours and on reasonable notice. You may also obtain a copy of the file for the actual cost of duplication. In addition, you may also be entitled to an oral summary of the information in your file by telephone. You must provide proper identification to inspect a file or obtain a copy or oral summary of your file. Sierra HR Partners, Inc. will provide personnel to explain information provided to you. You may also be accompanied by one other person.

I have read the Notice to Applicant and the Disclosure and fully understand their terms. I authorize the Company and Sierra HR Partners, Inc. to conduct a background investigation and prepare an investigative consumer report.

I wish to receive a copy of any report that is prepared.

I would like my copy of the prepared report sent to me via email at:

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November 27, 2020 11:59 am PDT

NOTICE TO APPLICANT AND AUTHORIZATION FORM Uploaded by Nancy Vang - tcrumpler@bctconsulting.com IP 73.90.81.230