FFPD – Waivers (Gumshoe) Initial

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E‐SIGN DISCLOSURE AND CONSENT ADDENDUM

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E-Sign Consent(Required)

I consent to use e-sign for communications.

I DO NOT consent to use e-sign for communications

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WAIVER AND RELEASE OF INFORMATION

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RELEASE AND WAIVER

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ADVISEMENT REGARDING DISCOVERY OF CRIMINAL ACTIVITY

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ADVISEMENT TO APPLICANTS REGARDING FALSE STATEMENTS

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Certification(Required)

I understand that any false statement and/or deliberate misrepresentations, whether by omission or commission, will result in my application being automatically and irrevocably rejected from further consideration. I certify that I have read the above statement, understand its contents, and have been furnished a copy of it.

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FAIR CREDIT REPORTING ACT DISCLOSURE & AUTHORIZATION DISCLOSURE

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ADVISEMENT TO CANDIDATE REGARDING CREDIT INFORMATION FOR EMPLOYMENT PURPOSES

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Certification(Required)

I certify that sponsoring agency and/or The Gumshoe Group has my consent to obtain a copy of my credit report for the limited purpose of my pre-employment background investigation; that I have been furnished with the name, address, and telephone number of the CRA, I have been informed that I will receive a copy of my credit report and that I have been informed in summary form of my rights under the FCRA.

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Prison Rape Elimination Act of 2003 (PREA) Applicant Questionnaire Form

Have you engaged in sexual abuse in a prison, jail, lockup, community confinement facility, juvenile facility or other institution (as defined in 42 U.S.C. 1997)?(Required)

Yes

If Yes, please explain:(Required)

Have you been convicted of engaging or attempting to engage in sexual activity in the community by force, overt or implied threats of force, or coercion, or if the victim did not consent or was unable to consent or refuse?(Required)

Yes

If Yes, please explain:(Required)

Have you ever been civilly or administratively adjudicated to have engaged in sexual activity in the community by force, overt or implied threats of force, or coercion, or if the victim did not consent or was unable to consent or refuse?(Required)

Yes

If Yes, please explain:(Required)

Prison Rape Elimination Act of 2003 (PREA) Applicant Questionnaire Form

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SECTION 1051 LABOR CODE WAIVER

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Statement of Knowledge and Compliance with Welfare & Institutions Code Section 15630

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Certification(Required)

I have read the above statement and understand its meaning. I hereby certify that in the event that I am appointed to this position, I will comply with the provisions of W & I Code Section 15630, and I understand this signed document will become a permanent part of my personnel file.

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Statement of Knowledge and Compliance with Penal Code Section 11166.5

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Certification(Required)

I have read the above statement and have been informed that the position I am seeking is a mandated reporter. I understand the reporting obligations described and will comply with those provisions of law.

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Date(Required)

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DISCLOSURE AND ELECTION FORM TO RECEIVE/NOT RECEIVE PUBLIC RECORDS

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Public Records(Required)

I hereby elect NOT to receive any public records which may be obtained by sponsoring agency for employment purposes under Civil Code section 1786.53.

I hereby elect to receive any public records which may be obtained and acknowledge that the sponsoring agency must provide me with a copy of any public records within seven (7) days of their receipt of such records.

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The Gumshoe Group!

FFPD – Waivers (Gumshoe) Initial

FFPD – Waivers (Gumshoe) Initial

Prison Rape Elimination Act of 2003 (PREA) Applicant Questionnaire Form