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HMA/AGG Quality Control Specialist
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Application Statement

APPLICATION STATEMENT

By eSigning and submitting this application, I hereby certify that all of the information provided by me in this application and any accompanying document is correct, accurate and complete to the best of my knowledge.  I understand that the falsification, misrepresentation, or omission of any facts will be cause for denial of employment or termination from employment if discovered later.


DISCLOSURE AND AUTHORIZATION REGARDING BACKGROUND INVESTIGATION FOR EMPLOYMENT PURPOSES

Disclosure

New Enterprise Stone & Lime Co., Inc. (the “Company”) may request from a consumer reporting agency and for employment-related purposes, a “consumer report(s)” (commonly known as “background reports”) containing background information about you in connection with your employment, or application for employment, or engagement for services (including independent contractor or volunteer assignments, as applicable). 

SwiftCheck will prepare or assemble the background reports for the Company.  SwiftCheck is located and can be contacted at 2009 Mackenzie Way Suite 100 Cranberry Township, PA 16066 - 800-505-8003 - swiftcheckscreening.com

The background report(s) may contain information concerning your character, general reputation, personal characteristics, mode of living, or credit standing.  The types of background information that may be obtained include, but are not limited to: criminal history; litigation history; motor vehicle record and accident history; social security number verification; address and alias history; credit history; verification of your education, employment and earnings history; professional licensing, credential and certification checks; drug/alcohol testing results and history; military service; and other information.

Authorization

By eSigning and submitting this application, I hereby authorize Company to obtain the consumer reports described above about me.


AUTHORIZATION FOR MOTOR VEHICLE REQUEST

By applying to this position, New Enterprise Stone & Lime Co., Inc. (the “Company”) will need to request and review an MVR (Motor Vehicle Report) as you will have the potential to operate a motor vehicle insured by the Company.  

Authorization

By eSigning and submitting this application, I understand that information contained in my employment application, or otherwise disclosed by me before or during my employment, if any, may be used for the purpose of obtaining and evaluating a motor vehicle request on me.  I also understand that nothing herein shall be construed as an offer of employment or contract for services.

I understand that failure to provide authorization for a motor vehicle request will either eliminate me from consideration for this position or jeopardize your driving privileges with our Company.

By eSigning and submitting this application, I hereby agree to allow the Company to request an MVR (Motor Vehicle Report) from the state in which your license was issued.  Any false statements or information provided may result in the loss of Company driving privileges and/or termination.


OTHER DISCLOSURES, ACKNOWLEDGMENTS & AUTHORIZATIONS REGARDING BACKGROUND INVESTIGATION FOR EMPLOYMENT PURPOSES

Disclosures

Investigative Consumer Report:

New Enterprise Stone & Lime Co., Inc.  (the “Company”) may request an investigative consumer report about you from SwiftCheck, a consumer reporting agency, in connection with your employment, or application for employment, or engagement for services (including independent contractor or volunteer assignments, as applicable).  An “investigative consumer report” is a background report that includes information from personal interviews (except in California, where that term includes background reports with or without information obtained from personal interviews), the most common form of which is checking personal or professional references through personal interviews with sources such as your former employers and associates, and other information sources.  The investigative consumer report may contain information concerning your character, general reputation, personal characteristics, mode of living, or credit standing.  You may request more information about the nature and scope of an investigative consumer report, if any, by contacting the Company.

Ongoing Authorization:

If the Company hires you or contracts for your services, the Company may obtain additional consumer reports and investigative consumer reports about you without asking for your authorization again, throughout your employment or your contract period, as allowed by law.

Additional State Law Notices:

Please also note the following:

NEW JERSEY:  You have the right to submit a request to the consumer reporting agency (e.g., SwiftCheck) for a copy of any investigative consumer report the Company requested about you. 

NEW YORK:  You have the right, upon written request to the Company, to be informed of whether or not the Company requested a consumer report or an investigative consumer report about you.  Shown above is the address and telephone number for SwiftCheck, the consumer reporting agency used by the Company.  You may inspect and receive a copy of any such report by contacting that consumer reporting agency.  A copy of Article 23-A of the New York Correction Law is also provided below.

Summary of Rights under the Fair Credit Reporting Act:

A summary of your rights under the Fair Credit Reporting Act is being provided to you separately.

Acknowledgments & Authorization

By eSigning and submitting this application, I acknowledge that I have received and carefully read and understand the separate “Disclosure and Authorization Regarding Background Investigation for Employment Purposes”; and the separate “Summary of Rights under the Fair Credit Reporting Act” that have been provided to me by the Company.  I also acknowledge receipt of and that I have carefully read and understand (as applicable), the separate California Disclosure and Summary of Rights under California Civil Code Section 1786.22; the separate New York Article 23-A; and the separate San Francisco Fair Chance Ordinance Official Notice that have been provided to me.

By my eSignature below, I authorize the preparation of background reports about me, including background reports that are “investigative consumer reports” by HireRight, and to the furnishing of such background reports to the Company and its designated representatives and agents, for the purpose of assisting the Company in making a determination as to my eligibility for employment  or engagement for services (including independent contractor or volunteer assignments, as applicable), promotion, retention or for other lawful employment purposes.  I understand that if the Company hires me or contracts for my services, my consent will apply, and the Company may, as allowed by law, obtain from HireRight (or from a consumer reporting agency other than HireRight) additional background reports pertaining to me, without asking for my authorization again, throughout my employment or contract period. 

I understand that if the Company obtains a credit report about me, then it will only do so where such information is substantially related to the duties and responsibilities of the position in which I am engaged or for which I am being evaluated.

I understand that information contained in my employment (or contractor or volunteer) application, or otherwise disclosed by me before or during my employment (or contract or volunteer assignment), if any, may be used for the purpose of obtaining and evaluating background reports on me.  I also understand that nothing herein shall be construed as an offer of employment or contract for services.

I understand that the information included in the background reports may be obtained from private and public record sources, including without limitation and as appropriate: government agencies and courthouses; educational institutions; and employers.  Accordingly, I hereby authorize all of the following, to disclose information about me to the consumer reporting agency and its agents: law enforcement and all other federal, state and local government agencies and courts; educational institutions (public or private); testing agencies; information service bureaus; credit bureaus and other consumer reporting agencies; other public and private record/data repositories; motor vehicle records agencies; my employers; the military; and all other individuals and sources with any information about or concerning me. The information that can be disclosed to the consumer reporting agency and its agents includes, but is not limited to, information concerning my: employment and earnings history; education, credit, motor vehicle and accident history; drug/alcohol testing results and history; criminal history; litigation history; military service; professional licenses, credentials and certifications; social security number verification; address and alias history; and other information. 

By my eSignature below, I also promise that the personal information I provide with this form or otherwise in connection with my background investigation is true, accurate and complete, and I understand that dishonesty or material omission may disqualify me from consideration for employment.  I agree that a copy of this document in faxed, photocopied or electronic (including electronically signed) form will be valid like the signed original.  I further acknowledge that I have received additional state law notices that I have reviewed and read.

Application Review

Candidate Sign Off

I certify that this application was completed by me, and that all entries on it and information in it are true and complete as of this date.