New Hire Authorization and Background

DISCLOSURE AND AUTHORIZATION FOR RELEASE OF INFORMATION

As part of our hiring background and investigation, we may obtain consumer reports to prepare an investigative consumer report. The investigative consumer report may consist of contacting all listed prior employers to verify your employment history. It may also include, but not be limited to, credit information reports, criminal history reports and driving history records. Under the provisions of the Fair Credit Reporting Act (15 USC at 1681-1681u) as amended, before we can seek such reports, we must have your written permission to obtain the information. You have the right, upon written request, to a complete and accurate disclosure of the nature and scope of the investigation. You are also entitled to a copy of your Consumer rights Under the Fair Credit Reporting Act.

AUTHORIZATION AND RELEASE TO OBTAIN INFORMATION

Under the provisions of the Fair Credit Reporting Act, 15 USC, Section 1681 et seq., the Americans with Disabilities Act and all applicable federal, state and local laws, I hereby authorize and permit TIERRA, INC. to obtain a consumer report and/or an investigative consumer report which may include the following:

1. My employment records;

2. Records concerning any driving, criminal history, credit history, civil record, workers’ compensation (post-offer only) and drug testing

3. Verification of my academic and/or professional credentials; and information and/or copies of documents from any military service records.

I understand that an “investigative consumer report” may include information as to my character, general reputation, personal characteristics and mode of living which may be obtained by interviews with individuals with whom I am acquainted or who may have knowledge concerning any such items of information.

I agree that a copy of this authorization has the same effect as an original.

I hereby release and hold harmless any person, firm or entity that discloses matters in accordance with this authorization, as well as TIERRA, INC. from liability that might otherwise result from the request for use of and/or disclosure of any or all of the foregoing information.

I understand and acknowledge that under the provision of the Fair Credit Reporting Act I may request a copy of any consumer report from the consumer reporting agency that compiled the report after I have provided proper identification.

I hereby authorize TIERRA, INC. to obtain and prepare an investigative consumer report as set forth above, as part of its investigation for my employment application.

Name *

First

Middle

Last

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Date of Birth *

Gender *

Current Driver's License No. *

Social Security *

Hire Location *

State Where DL Issued *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

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Phone Number *

Tierra Interviewer/ Contact *

Email *

As a job applicant, I freely and voluntarily agree to a urinalysis drug screen as part of my application for employment and I understand that a refusal to test, a positive confirmed drug test or a tampered with or an adulterated specimen will disqualify me from employment, even if I have started work pending the results of the drug test. I understand I am still completing the application process and will not officially be an employee until the company receives a negative pre-employment drug test result. If I am employed by this company, I understand and agree to abide by this company’s Drug-Free Workplace policy, under applicable State law.

Agree to the Authorization for Release of Information & Drug Screen *

I Agree

Disagree

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Today's Date

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