ACKNOWLEDGEMENT AND AUTHORIZATION. By signing below, I hereby authorize the obtaining of consumer reports and/or investigative consumer reports by the Company at any time after receipt of this authorization and throughout the course of my employment, if applicable. Signature: _ _ Date: _ First Name: _Middle Name: _ Last Name: _ Last Four Digits of SSN: __ _ Additional Information (for INTERNAL USE ONLY) In connection with my application for employment, I direct the following regarding my current employer: (please check one). Yes, my current employer may be contacted / No, my current employer cannot be contacted I understand that I have rights under the Fair Credit Reporting Act, and I acknowledge receipt of the Summary of Rights (initials). I authorize Company and Agency to use email communication with me to provide me with notices and information regarding any report or use of such report. If I do not have an email address or do not wish to share it, then communication will be by U.S. Mail, which will result in slower communication. If you have any questions concerning this background screening content, please contact: AmericanChecked, Inc. (Agency) at (000) 000-0000. Printed Full Name: Signature: Date: _/ / Company Name: _ Current Address: City State Zip Previous Address City State Zip For identification purposes: Social Security No.: Date of Birth: Driver’s License No.: _ _ _ State of Issue: _ Supplemental State Disclosures Connecticut applicants/employees only: If the Company obtains information bearing on your credit worthiness, credit standing or credit capacity, it will be because the information is substantially related to the job for which you are being considered/are currently occupying and to evaluate whether you would present an unacceptable risk of theft or other dishonest behavior in the job for which you are being considered/are currently occupying Maine applicants/employees only: You may contact the Company to request the name, address and telephone number of the nearest unit of AmericanChecked designated to handle inquiries, which Company shall provide within 5 business days. You have the right to request and promptly receive a copy of any investigative consumer report requested by Company by contacting the nearest unit of the Consumer Reporting Agency directly. Maryland applicants/employees only: If the Company obtains information bearing on your credit worthiness, credit standing or credit capacity, it will be because the information is substantially related to the job fo...
ACKNOWLEDGEMENT AND AUTHORIZATION. I have carefully read and understand the Disclosure regarding procurement of consumer reports provided by Orange County Parks and Recreation (“COMPANY”) and this Authorization to obtain a consumer report. A consumer report is a compilation of information that might affect your ability to participate with the Company. By my signature below, I hereby consent to the preparation by the National Center for Safety Initiatives (NCSI), a consumer reporting agency located at 0000 Xxxxxxxx Xxxx Xxxxx 000, Xxxxxxxx, XX 00000; tel. #000-000-0000; xxx.xxxxxxxxx.xxxxxxxx.xxx, of background reports regarding me and the release of such reports to the Company and its designated representatives, to assist the Company in making a participation decision involving me at any time after receipt of this authorization and throughout my participation engagement, to the extent permitted by law. By my signature below, I hereby authorize, without reservation, any state or federal law enforcement agency or court, educational institution, motor vehicle record agency, credit bureau or other information service bureau or data repository, or employer to furnish any and all information regarding me to NCSI and/or the Company itself and authorize NCSI to provide such information to the Company. I further certify the information provided on and in connection with this form is true, accurate and complete. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original. I acknowledge receipt of a copy of the Consumer Financial Protection Bureau’s “A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT.” Applicant Name (First, Full Middle, Last) Applicant Signature Today’s Date Para información en español, visite xxx.xxxxxxxxxxxxxxx.xxx/xxxxxxxxx o escribe a la Consumer Financial Protection Bureau, 0000 X Xxxxxx X.X., Xxxxxxxxxx, XX 00000. 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 FCRA. For more information, including information about additional rights, go to xxx.xxxxxxxxxxxxxxx.xxx/xxxxxxxxx or write to: Co...
ACKNOWLEDGEMENT AND AUTHORIZATION. The parties acknowledge that this Agreement constitutes a valid and legally binding obligation upon them and that it was signed by their respective authorized representatives, and each of them hereby confirms and ratifies its terms and conditions.
ACKNOWLEDGEMENT AND AUTHORIZATION. CLIENT and JFMEL acknowledge that each has read and agrees to the Terms and Conditions printed on the reverse side of this document that are incorporated herein and made a part of this Agreement. Per: Title: Date:
ACKNOWLEDGEMENT AND AUTHORIZATION. By signing below, I authorize COB and BPL, or its authorized agents to obtain or prepare consumer reports or investigative consumer reports about me. I acknowledge receipt of a copy of the federal notice entitled A Summary of Your Rights under the Fair Credit Reporting Act and certify that I have read this Disclosure and Authorization as well as the summary document explaining my rights under the Fair Credit Reporting Act. Location: I://drive – Volunteers – Forms & Applications
ACKNOWLEDGEMENT AND AUTHORIZATION. The above mentioned contract is hereby amended as follows;
ACKNOWLEDGEMENT AND AUTHORIZATION. This Change Order to the above mentioned contract was created to update the Procurement Officer information within the General Tab of ProcureAZ from Xxxx Xxxxxx to Xxxx Xxxxxxx. THIS CHANGE ORDER WAS PROCESSED AS A UNILATERAL CHANGE ORDER. ALL CONTRACT SPECIFICATIONS, TERMS AND CONDITIONS AND REQUIREMENTS REMAIN UNCHANGED. THIS DOCUMENT IS FOR INFORMATIONAL PURPOSES ONLY AND REQUIRES NO APPROVAL.
ACKNOWLEDGEMENT AND AUTHORIZATION. By checking the boxes and providing your electronic signature, you agree that you have read and understand the above contract terms of this Agreement, and agree with the interpretation of this contract as it has been explained to you. You also agree to the terms and recurring payments as stated above. You authorize SLC Muay Thai to submit and process payments through the debit or credit card or cards you have designated on your account. You hereby certify that you are the holder of the debit or credit card, or an authorized user of the account. Waiver and Release of Liability SLC Muay Thai 0000 x 000 x Xxx.3 (xxxxxxxxxxx@xxxxx.xxx) By checking the boxes and providing your electronic signature you agree to and acknowledge all terms of this release for all participants/members on your account and or as a parent or legal guardian of any participant/member minor [collectively hereinafter "participant" or "participants"] that is less than 18 years, old who wish to participate in practice sessions or events sponsored or conducted by Punisher Muay Thai Kickboxing and Fitness. In consideration of being allowed to participate in any way in the martial arts training, sports programs, and other events and activities conducted by SLC Muay Thai, you:
ACKNOWLEDGEMENT AND AUTHORIZATION. By signing below, I certify and acknowledge that the Company is authorized to defer payment of shares of Stock as indicated above and that I will be responsible for any taxes due as described in the Plan. I further acknowledge that my RSU Award and the shares of Stock related thereto are governed by the terms and conditions of the Plan document. The above acknowledgement and Participant Information is true, accurate and complete. Signed: _________________________________________________ Date: ____________________ As Plan Administrator, I hereby acknowledge receipt of this form.
ACKNOWLEDGEMENT AND AUTHORIZATION. (1) FTMS hereby grants the Dealer a non-exclusive and non-sole right to conduct the following activities on terms and conditions of this Contract:
