C4-Consent Form - Employment or Volunteer

CONSENT TO PERFORM CRIMINAL HISTORY BACKGROUND CHECK IN COMPLIANCE WITH THE FCRA (FAIR CREDIT REPORTING ACT)

This authorization and consent for release of personal information acknowledges that

(Hereafter referred to as “Company”)

and/or its agent, C4 Operations LLC, may now, or at any time I am enrolled in, assigned to, volunteer with or am employed by this Company, conduct investigations whether the records are of a public, private or confidential nature. These investigations might include, but are not limited to: searches of educational institutions attended; state driving records; financial or credit institutions; employment, including work history, efficiency ratings, complaints and grievances filed by or against me; records and recollections of attorney-at-law or other counsel, whether representing me or any other person (in either a civil or criminal case in which I have been involved); records from the U.S. Veteran’ Administration; criminal history information on file in local, state or federal agencies; and motor vehicle records, and following an employment offer, workers’ compensation reports from either the Department of Labor, National Personnel Records or the Industrial Commission or similar agencies under the provisions of the Fair Credit Reporting Act 15, USC section 1681 et seq. I also authorize the National Personnel Records Center, or other custodian of my military service record, to release to C4 Operations LLC, the following information and/or copies of documents from my military service record: DD214, service record, and any disciplinary records.

I understand that these searches can be used to determine eligibility under the Company policies. Therefore, I authorize the consent for full release of records (either orally or in writing) to the authorized representatives of the Company. I understand that according to the Federal Fair Credit Reporting Act, I am entitled to know whether employment was denied based upon the information obtained and received, upon written request, a disclosure of the background report. I also understand that I may request a copy of the report from C4 Operations LLC, by sending a written request to 1201 Edgewood Rd SW, Cedar Rapids IA 52404-2344, calling (888) 519-6283 or submitting an email request though our website www.C4Operations.com. After reading this document, I fully understand its contents and authorize the background verification.

Are you applying for employment in California, Minnesota or Oklahoma?

Yes

If so, do you want a copy of any Consumer Report prepared concerning you?

Yes

I understand that California law requires Company to give me a copy of any report requested within three (3) days of the date the information was obtained and that failure to do so will expose Company to liability (Section 1786.16).(Required)

Yes

Signed Date

Applicant (Print Name)

Applicant Signature

Parent/Legal Guardian Name if Applicant is a Minor

Parent/Guardian Signature if Applicant is a Minor