Common use of ACKNOWLEDGEMENT AND AUTHORIZATION Clause in Contracts

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 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. Massachusetts applicants/employees only: The precise nature and scope of any investigative consumer report will be the same as described in Background Check Disclosure. You have a right to obtain a copy of any investigative consumer report upon request from AmericanChecked Inc., 0000 Xxxxx Xxxxx Xxx. Ste. 120, Tulsa OK 74105, telephone 000-000-0000. Minnesota applicants/employees only: You have the right to request a complete and accurate disclosure of the nature and scope of any consumer report from AmericanChecked, Inc. 0000 Xxxxx Xxxxx Xxx. Ste. 120, Tulsa OK 74105, telephone 000-000-0000. New Jersey applicants/employees only: The precise nature and scope of any investigative consumer report will be the same as described in Background Check Disclosure. You have a right to obtain a copy of any investigative consumer report upon request from AmericanChecked, Inc. 0000 Xxxxx Xxxxx Xxx., Ste. 120, Tulsa OK 74105, telephone 000-000-0000. For Oregon 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. For Washington State applicants/employees only: You have the right, upon written request made within a reasonable period of time after your receipt of this disclosure, to receive from the Company a complete and accurate disclosure of the nature and scope of any “investigative” consumer report we may have requested. You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act. Any requests under this paragraph should be made to: AmericanChecked Inc., 0000 Xxxxx Xxxxx Xxx., Ste. 120, Tulsa OK 74105, telephone 000-000-0000. If the Company obtains information bearing on your credit worthiness, credit standing or credit capacity, it will be used to evaluate whether you would present an unacceptable risk of theft or other dishonest behavior in the job for which you are being considered.

ACKNOWLEDGEMENT AND AUTHORIZATION. By signing below, I hereby authorize certify that I have read and understand the obtaining of consumer reports and/or investigative consumer reports by items on this appointment form and that my answers are true and complete to the Company at any time after receipt of this authorization and throughout the course best of my employment, if applicableknowledge. Signature: _ _ Date: _ First Name: _Middle Name: _ Last Name: _ Last Four Digits of SSN: __ _ Additional Information I have been advised that MLIC and/or its affiliates (for INTERNAL USE ONLYcollectively “MetLife”) In may conduct investigations in connection with my application request to represent Metlife in the solicitation of certain products. I authorize an inquiry to be made of all sources deemed appropriate by Metlife for employmentthe purpose of obtaining information concerning my business practices and ethics, I direct the following regarding my current employer: (please check one). Yesbackground, credit history, and financial status, including, but not limited to, my current employer record, if any, on file with the FINRA Central Records Depository. Any information that MetLife may obtain about me will be treated as confidential and may be contacted / Noshared with the appointing general agent, my current employer cannot be contacted if necessary. I release the broker/dealer and/or its agents and any person or entity, which provide information pursuant to this authorization, from any and all liabilities, claims or lawsuits in any matter related to the information obtained from any and all of the above referenced sources used. I understand that no right to commission or other compensation shall arise or exist until I have rights under the Fair Credit Reporting Act, been appointed 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 reportall due diligence successfully approved. If I do not have an email address or do not wish am approved, I shall accept as full compensation for all services to share itbe performed by me, 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 compensation provided in the job for which you are being considered/are currently occupying Maine applicants/employees only: You applicable commission and compensation schedule as issued, substituted or changed. As an appointed producer, I shall observe and be bound by the rules of MetLife. FAIR CREDIT REPORTING ACT - As part of its regular procedures, MetLife may contact the Company to request the nameobtain an investigative consumer report. It may deal with character, address reputation, personal traits and telephone number of the nearest unit of AmericanChecked designated to handle inquirieslife style. It may involve personal interviews with friends, which Company shall provide within 5 business daysneighbors and associates. You I understand I have the right to make, within a reasonable amount of time, a written request for details on the name and promptly address of the agency making the report. I further understand that depending on the state law, subjects of an investigative consumer report may have the right to: 1) request that they be interviewed in connection with the making of the report; and 2) receive a copy of the report, upon request. My signature below constitutes my agreement and authorization to above. I understand that if any of the material information I provided is found to be incorrect or incomplete, MetLife may at its discretion not appoint and/or contract with me or terminate my appointment and/or contract. I agree to conduct my business in accordance with applicable laws and standards set forth by MetLife. Individual: Printed Name Signature Date If Agency, Company Officer Please Sign Here: Printed Name Signature Date MetLife Institutional U.S. Business Sales and Broker Compensation Services Disclosure By this document, Metropolitan Life Insurance Company on behalf of itself and its affiliates (collectively “MetLife”) discloses to you that a consumer report or an investigative consumer report requested by Company by contacting the nearest unit containing information as to your character, general reputation, personal characteristics and mode of living, is part of the Consumer Reporting Agency directlyprocess of our consideration of your application to become licensed or appointed to sell insurance and/or other products or to become registered with the Financial Industry Regulatory Authority. Maryland applicants/employees only: If the Company obtains information bearing on your credit worthiness, credit standing A consumer report 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. Massachusetts applicants/employees only: The precise nature and scope of any investigative consumer report will may be the same secured as described in Background Check Disclosurepart of a pre-appointment background investigation and at any time during your appointment with MetLife. You have a right to obtain a copy of any Should an investigative consumer report upon request from AmericanChecked Inc.be requested, 0000 Xxxxx Xxxxx Xxx. Ste. 120, Tulsa OK 74105, telephone 000-000-0000. Minnesota applicants/employees only: You you will have the right to request demand a complete and accurate disclosure of the nature and scope of any consumer report from AmericanChecked, Inc. 0000 Xxxxx Xxxxx Xxx. Ste. 120, Tulsa OK 74105, telephone 000-000-0000. New Jersey applicants/employees only: The precise nature the investigation requested and scope of any investigative consumer report will be the same as described in Background Check Disclosure. You have a right to obtain a copy of any investigative consumer report upon request from AmericanChecked, Inc. 0000 Xxxxx Xxxxx Xxx., Ste. 120, Tulsa OK 74105, telephone 000-000-0000. For Oregon 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. For Washington State applicants/employees only: You have the right, upon written request made within a reasonable period of time after your receipt of this disclosure, to receive from the Company a complete and accurate disclosure of the nature and scope of any “investigative” consumer report we may have requested. You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act. Any requests under this paragraph should be made to: AmericanChecked Inc., 0000 Xxxxx Xxxxx Xxx., Ste. 120, Tulsa OK 74105, telephone 000-000-0000. If the Company obtains information bearing on your credit worthiness, credit standing or credit capacity, it will be used to evaluate whether you would present an unacceptable risk of theft or other dishonest behavior in the job for which you are being considered.

ACKNOWLEDGEMENT AND AUTHORIZATION. By signing below, I You hereby authorize the obtaining of a consumer reports report and/or investigative consumer reports by the Company report at any time after receipt of this authorization by the Company, and if you are hired, throughout your employment, as permitted by law. You also confirm your understanding and provide consent for this report to be shared with a third-party for whom you may be placed to work as a representative of the course of my employmentCompany, 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: Signature Today’s Date Full Legal Name (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 print) Other or Former Names (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. (Agencyprint) at (000) 000-0000. Printed Full Name: Signature: Date: _/ / Company Name: _ Current Address: City Address City/State County Zip Previous Address City State Zip For identification purposes: Social Security No.: Date of Birth: ** SSN Name on Driver’s License No.: _ _ _ (if different from legal name) Driver’s License # State of Issue: _ Supplemental issued Contact Phone Number E-mail address **This information will be used for background screening purposes only and no other purpose. State Disclosures Connecticut applicants/Minnesota & Oklahoma applicants or employees only: If the Company obtains information bearing on Under state law you have a right to receive a copy of your credit worthinessconsumer report, credit standing or credit capacityfree of charge, it if one is requested by Company. By checking “yes”, a copy will be because provided to you at the information is substantially related address you provide on this notice. I would like to the job for which you are being considered/are currently occupying and to evaluate whether you would present an unacceptable risk receive a copy of theft my consumer report: ( ) Yes ( ) No New York applicants 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 Under state law you have the right to request inspect and promptly receive a copy of any investigative consumer report requested by Company by contacting the nearest unit National Crime Search, Inc. directly. You also acknowledge receipt of a copy of Article 23-A of the Consumer Reporting Agency directlyNew York Correction Law by signing the Disclosure and Authorization. Maryland applicants/Washington State applicants or 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 Under state law 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. Massachusetts applicants/employees only: The precise nature and scope of any investigative consumer report will be the same as described in Background Check Disclosure. You have a right to obtain request a copy of any investigative consumer report upon request from AmericanChecked Inc., 0000 Xxxxx Xxxxx Xxx. Ste. 120, Tulsa OK 74105, telephone 000-000-0000. Minnesota applicants/employees only: You have the right to request a complete and accurate disclosure of the nature and scope of any consumer report from AmericanChecked, Inc. 0000 Xxxxx Xxxxx Xxx. Ste. 120, Tulsa OK 74105, telephone 000-000-0000. New Jersey applicants/employees only: The precise nature and scope of any investigative consumer report will be the same as described in Background Check Disclosure. You have a right to obtain a copy of any investigative consumer report upon request from AmericanChecked, Inc. 0000 Xxxxx Xxxxx Xxx., Ste. 120, Tulsa OK 74105, telephone 000-000-0000. For Oregon 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. For Washington State applicants/employees only: You have the right, upon written request made within a reasonable period of time after your receipt of this disclosure, to receive from the Company a complete and accurate disclosure of the nature and scope of any “investigative” consumer report we may have requested. You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act’s disclosures to consumers (RCW 19.182.070) by contacting National Crime Search, Inc. directly. Any requests under this paragraph should be made toMassachusetts/New Jersey: AmericanChecked Inc.If you submit a request to National Crime Search, 0000 Xxxxx Xxxxx Xxx.Inc. in writing, Ste. 120, Tulsa OK 74105, telephone 000-000-0000. If you have the right to know whether the Company obtains information bearing on ordered an investigative consumer report from National Crime Search, Inc. You may inspect and order a free copy of the report by contacting National Crime Search, Inc. directly. California, Maine applicants or employees only: Under state law you have a right to receive a copy of your investigative consumer report and/or consumer credit worthinessreport, credit standing or credit capacityfree of charge, it if one is requested by Company. By checking “yes” a copy will be used provided to evaluate whether you at the address you provide on this Notice. I would present an unacceptable risk like to receive a copy of theft my consumer report: ( ) Yes ( ) No California applicants or other dishonest behavior in employees only: You acknowledge receipt of a copy of the job for which you are being consideredsummary of the provisions of California Civil Code section 1786.22 by signing the Disclosure and Authorization form.