COMBINED DISCLOSURE NOTICE AND AUTHORIZATION REGARDINGBACKGROUND CONSUMER REPORTSImportant: Please Read Carefully Before Signing

A consumer report and/or investigative consumer report including information concerning your character, employment history,general reputation, personal characteristics, police record, education, qualifications, motor vehicle record, mode ofliving and/orcredit and indebtedness may be obtained in connection with your application for and/or continued employment with theemployer. A consumer report and/or an investigative consumer report may be obtained at any time during theapplication process or during your employment with the employer. A consumer report containing injury and illness recordsmay be obtained after a tentative offer of employment has been made. Upon timely written request of the personnel departmentof the employer, and within 5 days of the request, the name, address and phone number of the reporting agency and the natureand scope of the investigative consumer report will be disclosed to you. Before any adverse action is taken, based in whole or inpart on the information contained in the consumer report, you will be provided a copy of the report, the name, address andtelephone number of the reporting agency, and a summary of your rights under the Fair Credit Reporting Act.

E For applicants residing in California, Minnesoto, or Oklahoma, check this box if you would like a copy of theconsumer report, if one is obtained.

NEW YORK APPLICANTS OR VOLUNTEERS ONLY: Upon reques! you will be informed whether or not a consumer report wasrequested, and if such report was requested, informed of the name and address of the consumer reporting agency that furnishedthe report. By signing below, you also acknowledge receipt of Article 23-A of the New York Correction Law.

CALIFORNIA APPLICANTS OR VOLUNTEERS ONLY: By signing below, you also acknowledge receipt of the NOTICE REGARDINGBACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW.

AUTHORIZATION

You hereby authorize and request, without any reservation, any present or former employer, school, police department, financialinstitution, division of motor vehicles, consumer reporting agencies, or other persons or agencies having knowledge about you tofurnish SmartStart Employment Screening on behalf of their client with any and all background information in their possessionregarding you, in order that your employment qualifications may be evaluated.

By signing below, you hereby authorize without reservation, any party or agency contacted by this employer / employer's agentto furnish the above mentioned information. You further authorize ongoing procurement of the above mentioned reports at anytime during your employment (or contractJ. You also agree that a fax, photocopy, or electronic signature [esignature) of thisauthorization may be accepted with the same authority as the original.

Your background investigation is conducted by SmartStart Employment Screening,29399 US 19 N - Ste 350, Clearwater, FL337 67. (873) 37 7 -4343, www,SmartStartEmploymentScreeninglnc.com.

READ, ACKNOWLBDGED AND AUTHORIZED

Signature Full Printed Name

Dttc of Birth Today's Date

Poro inlormoci6n en espdfiol, visite www.consumerlinonce.gov/leornmore o escribe o la Consumer FinoncialProtection Bureou, 17O0 G Street N.W., Woshington, DC 2O552.

A Summary of Your Rights Under the Fair Credit Reporting Act

The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy ofinformation 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 writinghistories, medical records, and rental history records). Here is a summary ofyour major rights under FCRA. Formore information, including information about additional rights, go towww.consumerfinance.sov/learnmore or write to: Consumer Financial Protection Bureau, 17OO G StreetN.W., Washington, DC 20552.

. You must be told if information in your file has been used against you. Anyone who uses a creditreport or another type of consumer report to deny your application for credit, insurance, oremployment - or to take another adverse action against you - must tell you, and must give you thename, 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 aboutyou in the files of a consumer reporting agency (your "file disclosure"). You will be required to provideproper identification, which may include your Social Security number. ln many cases, the disclosurewill 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 reporuo you are the victim of identity 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.

ln addition, all consumers are entitled to one free disclosure every 12 months upon request from each

nationwide credit bureau and from nationwide specialty consumer reporting agencies. See

www.consumerfinance.gov/learnmore for additional information.

. You have the right to ask for a credit score. Credit scores are numerical summaries ofyourcredit-worthiness based on information from credit bureaus. You may request a credit score fromconsumer reporting agencies that create scores or distribute scores used in residential real propertyloans, but you will have to pay for it. ln some mortgage transactions, you will receive credit scoreinformation for free from the mortgage lender.

o You have the right to dispute incomplete or inaccurate information. lf you identify information inyour file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agencymust investigate unless your dispute is frivolous. See www.consu merfina nce.eov/lea rnmore for an

explanation of d ispute procedures.

. Consumer reporting a8encies must correct or delete inaccurate, incomplete, or unverifiableinformation. lnaccurate, incomplete, or unverifiable information must be removed or corrected,usually within 30 days. However, a consumer reporting agency may continue to report information ithas verified as accurate.

Consumer reporting agencies may not report outdated negative information. ln most cases, a

consumer reporting agency may not report negative information that is more than seven years old, orbankruptcies that are more than 10 years old.

Access to your file is limited. A consu mer reporting agency may provide information a bout you only topeople 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 potentialemployer, without yourwritten consent given to the employer. Written consent generally is not required in the truckingindustry. For more information, go to www.consu merfinance.sov/lea rnmore.

You may limit "prescreened" offers of credit and insurance you get based on information in yourcredit 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 form the lists these offers are

based on. You may opt out with the nationwide credit bureaus at 1-888-5-0PTOUT (1-888-567-8688).

The following FCRA right applies with respect to nationwide consumer reporting agencies:

Cor.rsututns Hlve rsr Rrexr To OerarN l Srcunrrv Fnrrzr

You have a right to place a "security freeze" on your credit report, which will prohibit a consumerreporting agency from releasing information in your credit report without Vour express

authorization. The security freeze is designed to prevent credit, loans, and services from being

approved in your name without your consent. However, you should be aware that using a securityfreeze to take control over who gets access to the personal and financial information in your creditreport may delay, interfere with, or prohibit the timely approval of any subsequent request orapplication you make regarding a new loan, credit, mortgage, or any other account involving theextension of credit.

As an alternative to a security freeze, you have the right to place an initial or extended fraud alert onyour credit file at no cost. An initial fraud alert is a 1-year alert that is placed on a consumer's creditfile. Upon seeing a fraud alert display on a consumer's credit file, a business is required to take steps toverify the consumer's identity before extending new credit. lf you are a victim of identity theft, you are

entitled to an extended fraud alert, which is a fraud alert lasting 7 years.

A security freeze does not apply to a person or entity, or its affiliates, or collection agencies acting onbehalf ofthe person or entity, with which you have an existing account that requests information in

your credit report for the purposes of reviewing or collecting the account. Reviewing the accountincludes activities related to account maintenance, monitoring, credit line increases, and accountupgrades and enhancements.

You may seek damages from violators. lf a consumer reporting agency, or, in some cases, a user ofconsumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, youmay be able to sue in state or federal court.

ldentity theft victims and active duty military personnel have additional rights. For moreinformation, visit www.consumerfinance.gov/learnmore.

States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, youmay have more rights under state law. For more information, contact your state or local consumerprotection agency or your state Attorney General. For information about your federal rights, contact:

TYPE OF BUSINESS: CONTACT:Banks, savlngs associations, and credit unions with total assets of Consumer Frnancial Prolection Bureauover $1 0 billion and their affiliates. 1700 G Street NW

Washington, DC 20552Such affiliates that are not banks. savings associations, or credit Federal Trade Commission: Consumer Response Center- FCRAunions also should list, in addition to the CFPB:1.a. Banks, savings Washington, DC 20580associations, and credit unions with total assets of (877\ 382-4357over $10 billion and their affiliates.To the extent not included in item 1 above:Nalional banks, federal savings associalions, and federal branches Office of the Comptroller of the Currencyand federal agencies of foreign banks Customer Assistance Group

130'1 McKinney Street, Suite 3450Houston, TX 77010-9050

State member banks, branches and agencies of foreign banks (other Federal Reserve Consumer Help Centerthan federal branches, federal agencies, and lnsured State Branches of P.O. Box '1200

Foreign Banks). commercial lending companies owned or controlled by Minneapolis, MN 55480foreign banks, and organizations operating under section 25 or 25A of theFederal Reserue ActNonmember lnsured Banks, lnsured State Branches of Foreign FDIC Consumer Response CenterBanks, and insured state savings associations 1 1 00 Walnut Street, Box #1 1

Kansas City, MO 64106Federal Credit Unions National Credit Union Administration

Omce of Consumer Protection (OCP)Division of Consumer Compliance and Outreach (DCCO)1775 Duke StreetAlexandria, VA 22314

Air carriers Asst. General Counsel for Aviation Enforcement & ProceedingsAviation Consumer Protection DivisionDepartment of Transportalion1200 New Jersey Avenue, SEWashington, DC 20590

Creditors Subject to Surface Transportation Board Office of Proceedings, Surface Transportation BoardDepartment of Transportation395 E Street S.W.Washington, DC 20423

Creditors Subject to Packers and Stockyards Act, 1921 Nearest Packers and Stockyards Administration area supervisorSmall Business lnvestment Companies Associate Deputy Administrator for Capital Arcess

United States Small Business Administration409 Third Street, SW, 8th FloorWashington, DC 20416

Brokers and Dealers Securities and Exchange Commission1OO F St NEWashington, DC 20549

Federal Land Banks. Federal Land Bank Associations, Federal Farm Credit Administrationlntermediate Credit Banks, and Production Credit Associations 1501 Farm Credit Drive

Mclean, VA 221O2-5OSORetailers, Finance Companles, and All Other Creditors Not Listed FTC Regional Otnce for region in which the creditor operates orAbove Federal Trade Commission: Consumer Response Center- FCRA

Washington, DC 20580(877) 3824357

New York Article 23-A Correction Law$ 750. Definitions. For the purposes of this article, the following terms shall have the following meanings: (1) "Public agency"means the state or any local subdivision thereof, or any state or local department, agency, board or commission. (2J "Privateemployer" means any person, company, corporation, labor organization or association which employs ten or more persons. [3)"Direct relationship" means that the nature of criminal conduct for which the person was convicted has a direct bearing on hisfitness or ability to perform one or more ofthe duties or responsibilities necessarily related to the license, opportunity, orjob inquestion. (4J "License" means any certificate, license, permit or grant of permission required by the laws of this state, its politicalsubdivisions or instrumentalities as a condition for the lawful practice of any occupation, employment, trade, vocation, business,or profession. Provided, however, that "license" shall not, for the purposes ofthis article, include any license or permit to own,possess, carry, or fire any explosive, pistol, handgun, rifle, shotgun, or other firearm. (5J "Employment" means any occupation,vocation or employment, or any form of vocational or educational training. Provided, however, that "employment" shall not, forthe purposes of this article, include membership in any law enforcement agency.

$ 751. Applicability. The provisions of this article shall apply to any application by any person for a license or employment at anypublic or private employer, who has previously been convicted of one or more criminal offenses in this state or in any otherjurisdiction, and to any license or employment held by any person whose conviction of one or more criminal offenses in this stateor in any other jurisdiction preceded such employment or granting of a license, except where a mandatory forfeiture, disability orbar to employment is imposed by law, and has not been removed by an executive pardon, certificate of relief from disabilities orcertificate of good conduct. Nothing in this article shall be construed to affect any right an employer may have with respect to anintentional misrepresentation in connection with an application for employment made by a prospective employee or previouslymade by a current employee.

$ 752. Unfair discrimination against persons previously convicted of one or more criminal offenses prohibited. No application forany license or employment, and no employment or license held by an individual, to which the provisions of this article areapplicable, shall be denied or acted upon adversely by reason of the individual's having been previously convicted of one or morecriminal offenses, or by reason of a finding of lack of "good moral character" when such finding is based upon the fact that theindividual has previously been convicted of one or more criminal offenses, unless:(1J there is a direct relationship between one or more of the previous criminal offenses and the specific license or employment

sought or held by the individual; or(2J the issuance or continuation of the license or the granting or continuation of the employment would involve an unreasonablerisk to property or to the safety or welfare of specific individuals or the general public.

$ 753. Factors to be considered concerning a previous criminal conviction; presumption. 1. In making a determination pursuant tosection seven hundred fifty-two of this chapter, the public agency or private employer shall consider the following factors: [a] Thepublic policy ofthis state, as expressed in this act, to encourage the licensure and employment ofpersons previously convicted ofone or more criminal offenses. [bJ The specific duties and responsibilities necessarily related to the license or employment soughtor held by the person. [cJ 1'he bearing, if any, the criminal offense or offenses for which the person was previously convicted willhave on his fitness or ability to perform one or more such duties or responsibilities. (dJ The time which has elapsed since theoccurrence of the criminal offense or offenses, [eJ The age of the person at the time of occurrence of the criminal offense oroffenses. (fJ The seriousness ofthe offense or offenses. [gJ Any information produced by the person, or produced on his behall inregard to his rehabilitation and good conduct. [hJ The legitimate interest ofthe public agency or private employer in protectingproperty, and the safety and welfare of specific individuals or the general public. 2. In making a determination pursuant to sectionseven hundred fifty-two of this chapter, the public agency or private employer shall also give consideration to a certificate of relieffrom disabilities or a certificate of good conduct issued to the applicant, which certificate shall create a presumption ofrehabilitation in regard to the offense or offenses specified therein.

$ 754. Written statement upon denial of license or employment. At the request of any person previously convicted of one or morecriminal offenses who has been denied a license or employment, a public agency or private employer shall provide, within thirtydays of a request, a written statement setting forth the reasons for such denial.

$ 755. Enforcement. 1. In relation to actions by public agencies, the provisions of this article shall be enforceable by a proceedingbrought pursuant to article seventy-eight of the civil practice law and rules. 2. In relation to actions by private employers, theprovisions of this article shall be enforceable by the division of human rights pursuant to the powers and procedures set forth inarticle fifteen of the executive law, and, concurrently, by the New York city commission on human rights.

NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW

This employer intends to obtain information about you for "employment purposes" from an investigative consumer reportingagency or consumer credit reporting agency. Thus, you can expect to be the subject of"investigative consumer reports" and"consumer credit reports" obtained for "employment purposes." Such reports may include information about your character,general reputation, personal characteristics and mode of living. With respect to any investigative consumer report from aninvestigative consumer reporting agency ('lCM"l, the Company may investigate the information contained in your applicationand other background information about you, including but not limited to obtaining a criminal record report, veri$ing references,work history, your social security number, your educational achievements, licensure, and certifications, your driving record, andother information about you, and interviewing people who are knowledgeable about you. The results of this report may be usedas a factor in making decisions for "employment purposes." The source of any investigative consumer report (as that term isdefined under California lawJ will be SmartStart Employment Screening Inc, Consumer Disputes, PO Box 61237, Raleigh, NC27 611 (9L9) 355-5053. www.SmartStartE,mploymentScreeninglnc.com.

The Company agrees to provide you with a copy of an investigative consumer report when required to do so under California law.Under California Civil Code section 7786.22, you are entitled to find out from an ICRA what is in the ICRA's file on you with properidentification, as follows: In person, by visual inspection of your file during normal business hours and on reasonable notice. Youalso may request a copy of the information in person.

The ICRA may not charge you more than the actual copying costs for providing you with a copy of your file. A summary of allinformation contained in the ICM's file on you that is required to be provided by the California Civil Code will be provided to youvia telephone, if you have 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 you.

By requesting a copy be sent to a specified addressee by certified mail. ICMs complying with requests for certified mailings shallnot be liable for disclosures to third parties caused by mishandling of mail after such mailings leave the ICMs.

"Proper Identification" includes documents such as a valid driver's license, social security account number, military identificationcard, and credit cards. Only if you cannot identify yourself with such information may the ICRA require additional informationconcerning your employment and personal or family history in order to veri$r your identity.

The ICM will provide trained personnel to explain any information furnished to you and will provide a written explanation of anycoded information contained in files maintained on you. This written explanation will be provided whenever a file is provided toyou for visual inspection.

You may be accompanied by one other person of your choosing, who must furnish reasonable identification. An ICRA may requireyou to furnish a written statement granting permission to the ICRA to discuss your file in such person's presence.

VERMONT - Notice of Requirement for Consumer Consent

Under Vermont law, no one may access a Vermont consumer's credit report without obtaining the consumer's permission exceptunder the following limited circumstances:(AJ in response to the order of a court having jurisdiction to issue such an order;(BJ for direct mail offers of credit (prescreening), as permitted by the FCM;(CJ for the purpose ofreviewing an account, increasing the credit line on the account, taking collection action on the account, orfor other legitimate purposes associated with the account, if the consumer has given ongoing permission to obtain reports inconnection with an existing credit relationship;(D) where the request for a credit report is related to an education loan made, guaranteed, or serviced by the Vermont StudentAssistance Corporation;(EJ where the request for a credit report is by the Office of Child Support Services when investigating a child support case;(FJ where the request for a credit report is related to a credit transaction entered into prior to January 1, 1993; or(G) where the request for a credit report is by the Vermont State Tax Department and is used for the purpose of collecting orinvestigating delinquent taxes.Ifyou have obtained consent from the consumer to receive their credit report, the report may only be used for the purposeconsented to by the consumer

The Vermont statute above is provided to you with the intention of increasing awareness of your responsibilities underVT2aBOe[b) only. The notice is not meant to be an exhaustive representation of all Vermont laws affecting credit report users norofyour obligations under such laws. In short, it is not intended to provide you with, nor shall it be construed as, legil adviceregarding Vermont law.