Employment Application

Programs, services, and employment are equally available to everyone. Please inform the Human Resources Department if you require reasonable accommodations for the application or interview. Date of Interview
/ /
Applicant Data: Position Applied for:
How were you referred to us:

 

Full Name:
Preferred Name:
Address:
City:
State:
Zip Code:
Home Phone:
Cell Phone:
Date Available to Start:
Social Security #:
Emergency Contact:
Relationship to Employee:
Emergency Contact Phone #:
If your are under 18 and we require a work permit, can you furnish one: Yes     No
Have you ever worked for this company?     Yes     No If yes, when?
Are you a citizen of the United States? Yes     No
If not, are you legally allowed to work in the United States? Yes     No
Type of employment desired:       Full-Time       Part-Time       Salary requirement:
Have you ever pleaded "guilty," "no contest," or been convicted of a crime? Yes     No
If yes, give dates and details:
Answering "yes" to these questions does not constitute an automatic rejection from employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.
Summarize Your Special Skills Or Qualifications

 

PREVIOUS EMPLOYMENT (begin with most recent position):
Dates of Employment:   From // To //   Position(s) Held:
Firm:
Address:
Phone:
Supervisor:
Title:
Responsibilities:
Starting Salary and Title:
Ending Salary and Title:
Reason for Leaving:
May we contact this employer for a reference? Yes     No
 
Dates of Employment:   From // To //   Position(s) Held:
Firm:
Address:
Phone:
Supervisor:
Title:
Responsibilities:
Starting Salary and Title:
Ending Salary and Title:
Reason for Leaving:
May we contact this employer for a reference? Yes     No
 
Dates of Employment:   From // To //   Position(s) Held:
Firm:
Address:
Phone:
Supervisor:
Title:
Responsibilities:
Starting Salary and Title:
Ending Salary and Title:
Reason for Leaving:
May we contact this employer for a reference? Yes     No

 

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby release employers, schools or individuals from all liability when responding to inquiries in connection with my application.

In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

Signature of Applicant: Date: //

 

Para informacion en espanol, visite www.ftc.gov/credit o
escribe a la FTC Consumer Response Center, Room 130-A 600
Pennsylvania Ave. N.W., Washington, DC 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, DC 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:
    • A person has taken adverse action against you because of information in your credit report;
    • You are the victim of identify theft and place a fraud alert in your file;
    • Your file contains inaccurate information as a result of fraud;
    • You are on public assistance;
    • 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 for 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 1-888-567-8688.
  • 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. Federal enforcers are:

 

TYPE OF BUSINESS: CONTACT:
Consumer reporting agencies, creditors and others not listed below Federal Trade Commission:
Consumer Response Center - FCRA

Washington, DC 20580
1-877-382-4357
National banks, federal branches/agencies of foreign banks (word "National" or initials "N.A." appear in or after bank's name) Office of the Comptroller of the Currency
Compliance Management Mail Stop 6-6
Washington, DC 20219
1-800-613-6743
Federal Reserve System member
banks (except national banks and
federal branches/agencies of
foreign banks)
Federal Reserve Board Division of Consumer & Community Affairs
Washington, DC 20551
202-452-3693
Savings associations and federally
chartered savings banks (word
"Federal" or initials "F.S.B." appear
in federal institution's name)
Office of Thrift Supervision Consumer Complaints
Washington, DC 20552
800-842-6929
Federal credit unions (words "Federal Credit Union" appear in institution's name) National Credit Union Administration
1775 Duke Street
Alexandria, VA 22314
703-519-4600
State-chartered banks that are not members of the Federal Reserve System Federal Deposit Insurance Corporation
Consumer Response Center
2345 Grand Avenue, Suite 100
Kansas City, Missouri 64108-2638
1-877-275-3342
Air, surface, or rail common carriers regulated by former Civil Aeronautics Board or Interstate Commerce Commission Department of Transportation
Office of Financial Management
Washington, DC 20590
202-366-1306
Activities subject to the Packers and Stockyards Act of 1921 Department of Agriculture
Office of Deputy Administrator - GIPSA
Washington, DC 20250
202-720-7051

 

CONSUMER REPORT CHECK AUTHORIZATION

 

Name: Last First M.I.

Address:

City: State: Zip:

SSN: Birth Date:

Home Phone: Mobile Phone:

Have you ever worked for this company?   Yes   No   If yes, when?

Are you a citizen of the United States?   Yes  

If not, are you legally allowed to work in the United States?   Yes  

Have you ever pleaded "guilty", "no contest" or been convicted of a crime?   Yes  

If yes, give details:

Answering "yes" to these questions does not constitute an automatic rejection of a working relationship with this company. Date of the offense, seriousness and nature of the violation, rehabilitation will be considered.

The information contained in this application is correct to the best of my knowledge. I hereby authorize Columbia Advance Group, LLC and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment purposes. I understand that the scope of the consumer report/ investigative consumer report may include, but is not limited to the following areas: verification of social security number; current and previous residences; employment history, education background, character references; drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records.

I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to Columbia Advance Group, LLC or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources.

Signature of Applicant: Date: //
Printed Name:

 

9120 NE Vancouver Mall Loop, Suite 140
Vancouver, WA. 98662

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