Monica Woods

I have never bee in any kind of trouble. I graduated school in 2018. I was in NJROTC. I did peer tutoring in High School on my last year. I modeled for years locally. I always wanted to go into the medical field. My plan is to go back to Ivy Tech and become a Rad Tech. I am applying for this hospital job to gain some experience.

• FOR DISCLOSURE AND ACKNOWLEDGEMENT
• IMPORTANT – PLEASE READ CAREFULLY BEFORE SIGNING ACKNOWLEDGMENT
• NEW ADDITIONS HAVE BEEN MADE JANUARY 2014 IN ORDER TO COMPLY WITH
• THE FCRA ARTICLE 613.
• DISCLOSURE REGARDING BACKGROUND INVESTIGATION
• Clean Team, Inc. (the “Company”) may obtain information about you for employment purposes from the following consumer reporting agency (“the Agency”): BSCAI Background Checks, 1200 NW South Outer Road, Corporate Centre, Blue Springs, MO 64015, Phone: 816-875-3701, Fax: 816-224-9699, or from another outside organization. The Agency’s privacy policy can be found at http://www.bscaibackgroundchecks.com.
• Thus, you may be 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. These reports may be obtained at any time after receipt of your authorization and, if you are hired, throughout your employment. These reports may include, but are not limited to, checks regarding your criminal history, social security trace, employment and education references, driving history, professional licenses, and credentials. Credit history will be requested only in accordance with applicable law. These reports may contain information regarding your use of social media, and other publicly accessible information. Social media includes, but is not limited to, social networking websites (i.e., Facebook and others), professional networking websites (i.e., LinkedIn and others), blogs, and other online media.
• You have the right, upon written request made within a reasonable time after receipt of this notice, to ask the Company to disclose the nature and scope of any consumer report. You also may request a copy of any report from the Company. If an “employer” other than the Company furnishes an investigative consumer report, the Company will provide relevant contact information within five business days of your request. An “investigative consumer report” is a background report that includes information from personal interviews (except in California, where the Company does not request or rely on the results of any personal interviews). 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 education and/or employment history conducted by the Agency via interviews with past employers, neighbors, friends or associates. The scope of this disclosure and authorization is all-encompassing, however, allowing the Company to obtain from any outside organization all manner of consumer reports and investigative consumer reports now and, if you are hired, throughout the course of your employment to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report.
• ACKNOWLEDGMENT AND AUTHORIZATION
• I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT (see back page) and certify that I have read and understand both of these documents. I hereby authorize the procurement 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. I understand that these reports may include information about my character, general reputation, personal characteristics, and/or mode of living, whichever may be applicable. I also authorize the Company to share this information with any person or entity making a request for information about me. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, 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 BSCAI Background Checks, 1200 NW South Outer Road, Corporate Centre, Blue Springs, MO 64015, Phone: 816-875-3701, Fax: 816-224-9699, and/or the Company itself. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original.
• Maine, Massachusetts, and New Jersey employees only: You have the right to inspect and promptly receive a copy of any investigative consumer report requested by Company by contacting the consumer reporting agency identified above directly.
• Minnesota employees only: You have the right, upon written request to Agency, to receive a complete and accurate disclosure of the nature and scope of any consumer report. Agency must make this disclosure within five days of receipt of your request or of the Company’s request for the report, whichever is later. New York employees only: You have the right to request whether Company requested a consumer report and, if so, Company will give you the name and address of the report’s provider if other than Agency.
• California, Minnesota and Oklahoma employees only: Please check this box if you would like to receive from Agency a copy of any report furnished by Agency to the Company pursuant to your authorization. [ ]
• Washington employees only: The Company will provide the disclosure described above concerning its procurement of an investigative consumer report either five days after receiving your request or after requesting the investigative consumer report, whichever is later. You have the right to ask Company to provide you with a summary of your rights under the Washington Fair Credit Reporting Act.
• I authorize Clean Team, Inc. to deduct $17.50 from my first paycheck for reimbursement for the consumer report.
• First Name
• Middle Name
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• Social Security Number:
• Date of Birth:
• Driver’s License/ID State (optional):
• Driver’s License/ID Number (optional):
• Current Address (Required): Street
• City
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• Contact Telephone Number:
• E-Mail Address:
• SIGNATURE:
• DATE:
• Para informacion en espanol, visite www.ftc.gov/credit
• Escriba a la FTC Consumer Response Center, Room 130-A

• 600 Pennsylvania Ave. N.W., Washington, D.C. 20580.
• A Summary of Your Rights Under the Fair Credit Reporting Act
• The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to www.ftc.gov/credit or write to: Consumer Response Center, Room 130-A, Federal Trade Commission, 600 Pennsylvania Ave. N.W., Washington, D.C. 20580.
• You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment – or to take another adverse action against you – must tell you, and must give you the name, address, and phone number of the agency that provided the information.
• You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your “file disclosure”). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:
• O a person has taken adverse action against you because of information in your credit report;
• O you are the victim of identify theft and place a fraud alert in your file;
• O your file contains inaccurate information as a result of fraud;
• O you are on public assistance;
• O you are unemployed but expect to apply for employment within 60 days.
• In addition, by September 2005 all consumers will be entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.ftc.gov/credit for additional information.
• You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender.
• You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See www.ftc.gov/credit for an explanation of dispute procedures.
• Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate. Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old.
• Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need – usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access.
• You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to www.ftc.gov/credit.
• You may limit “prescreened” offers of credit and insurance you get based on information in your credit report. Unsolicited “prescreened” offers of credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-5-OPTOUT (1-888-567-8688).
• You may seek damages from violators. If a consumer reporting agency, or in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.
• Identity theft victims and active duty military personnel have additional rights. For more information, visit www.ftc.gov/credit.
• States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General.