This certifies by me that this request was completed by me, and that all entries on it and information on it are true and complete to the best of my knowledge.
FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT
BACKGROUND CHECK DISCLOSURE FedEx Ground Package System, Inc. (The “Company” hereafter) will order a background report on you in connection with your current or prospective engagement by a Contracted Service Provider or Third Party Staffing Company doing business with the Company, and if you are engaged, or if you already are engaged, may order additional background reports on you in connection with your current or prospective engagement. A background report may contain information concerning your character, general reputation, personal characteristics, mode of living, criminal history and credit standing. Information may be obtained from private and public record sources. BACKGROUND CHECK AUTHORIZATION I authorize the Company to order my background check. I understand that, as allowed by law, the Company may rely on this authorization to order additional background reports without asking me for my authorization again (1) during my engagement with a Contracted Service Provider or Third Party Staffing Company doing business with the Company, and (2) from companies other than the consumer reporting agencies (“CRA”) identified below. I also authorize all of the following to disclose to any CRA and its agents all information about or concerning me, including: my past or present employers; learning institutions, including colleges and universities; law enforcement and all other federal, state and local agencies; federal, state and local courts; the military: credit bureaus; testing facilities; motor vehicle records agencies; all other private and public sector repositories of information; and any other person, organization, or agency with any information about or concerning me. The information that can be disclosed to the CRA and its agents includes, but is not limited to, information concerning my employment and earnings history, education, credit history, motor vehicle history, criminal history, military service, professional credentials and licenses. Please review the information below about your rights under local law BEFORE you click, “I ACCEPT.” I understand that by clicking on “I ACCEPT” below, and clicking on the submit button below, I am electronically signing this Authorization. I understand that my electronic signature will be binding as though I had physically signed this document by hand. I agree that a printout of this authorization may be accepted with the same authority as the original. STATE SPECIFIC NOTES The background report company (or “CRA”), InfoMart or First Advantage, will prepare the background report for the Company. These CRAs are located at: InfoMart, 1582 Terrell Mill Road, Marietta, GA 30067, or First Advantage, 1 Concourse Parkway NE, Suite 200, Atlanta, GA 30328, and can be reached at 1-800-800-3774 (InfoMart) or 1-800-321-4473 (First Advantage). The privacy policies for the CRAs can be found on the their Websites: www.infomart.usa.com (InfoMart) or www.fadv.com (First Advantage). If you live or are engaged in any of the states listed below, please note the following: CALIFORNIA: You have a right to view the file that any CRA has with your information, and order a copy of the file, upon submitting proper identification (such as valid driver’s license, Social Security account number, military identification card or credit card) and paying actual copying costs, by coming to their offices, during normal business hours and on reasonable notice. You also have a right to submit a written request, to include proper identification, for a copy of your file to be sent by certified mail or for a telephonic file summary. The CRA will provide trained personnel to explain to you the information furnished and can answer questions about information in your file including any coded information. If you come to their offices in person, another person can join you, so long as that person can show proper identification. More specific information is set out below. MINNESOTA: You have the right in most circumstances to submit a written request to any CRA for a complete and accurate disclosure of the nature and scope of any consumer report the Company ordered about you. The CRA must provide you with this disclosure within five business days after its receipt of your request was requested by the Company, whichever date is later. NEW YORK: If you contact the Company, you have the right to know whether the Company ordered a consumer report or investigative consumer report about you. Shown above is the address and telephone number for the CRAs. You have the right to contact any CRA to inspect or receive a copy of any such report. A copy of Article 23-A of the Correction Law is available will be provided to you as a “hard” or paper copy. If you live or are engaged in California, Minnesota or Oklahoma: Check this box if you would like a free copy of our background report: All residents of California, Minnesota and Oklahoma will be provided with a free copy of their background report whether or not they check the box. (CALIFORNIA ONLY) A summary of Your Rights Under California Civil Code Section 1786.22
An investigative consumer reporting agency shall supply files and information required under Section 1786.10 during normal business hours and on reasonable notice. Files maintained on a consumer shall be made available for the consumer’s visual inspection, as follows:
In person, if he or she appears in person and furnishes proper identification. A copy of his or her file shall also be available to the consume for a fee not to exceed the actual costs of duplication services provided
By certified mail, if he or she makes a written request, with proper identification, for copies to be sent to a specified addressee. Investigative consumer reporting agencies complying with the requests for certified mailings under this section shall not be liable for disclosers to third parties caused by mishandling of mail after such mailings leave the investigative consumer reporting agencies.
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.
The term “proper identification” as used in subdivision (b) shall mean that information generally deemed sufficient to identify a person. Such information includes documents such as a valid driver’s license, social security account number, military identification card, and credit cards. Only if the consumer is unable to reasonably identify himself or herself with the information described above, may an investigative consumer reporting agency require additional information concerning the consumer’s employment and personal or family history in order to verify his or her identity.
The investigative consumer reporting agency shall provide trained personnel to explain to the consumer any information furnished him or her pursuant to Section 1786.10.
The investigative consumer reporting agency shall provide a written explanation of any coded information contained in files maintained on the consumer. This written explanation shall be distributed whenever a file is provided to a consumer for visual inspection as required under Section 1786.22.
The consumer shall be permitted to be accompanied by one other person of his or her choosing, who shall furnish reasonable identification. An investigative consumer reporting agency may require the consumer to furnish a written statement granting permission to the consumer reporting agency to discuss the consumer’s file in such person’s’ presence.
Employer Verification Disclosure Statement PURSUANT TO THE PROVISIONS OF PARAGRAPH (B) OF (10) OF SECTION 391.21 OF THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS YOU ARE HERIN NOTIFIED THAT IF YOU ARE TO BE CONSIDERED FOR CONTRACTING OR DRIVING BY FEDEX GROUND, 1000 FEDEX DRIVE, MOONTOWNSHIP, PA 15108, THE INFORMATION WHICH YOU HAVE PROVIDED IN ACCORDANCE WITH THIS PARAGRAPH MAY BE SUED, AND YOUR PRIOR EMPLOYERS MAY BE CONTACTED, FOR THE PURPOSES OF INVESTIGATING YOUR BACKGROUND AS REQUIRED BY SECTION 391.23.
