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DISCLOSURE REGARDING BACKGROUND INVESTIGATION EMPLOYER (City of Laramie) may obtain information about you from a third-party consumer reporting agency for employment purposes. Thus, you may be the subject of a “consumer report” and/or an “investigative consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources such as your neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records (“driving records”), verification of your education or employment history, or other background checks. Credit history will only be requested where such information is substantially related to the duties and responsibilities of the position for which you are applying. You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you, and disclosure of the nature and scope of any investigative consumer report and to request a copy of your report. Please be advised that the nature and scope of the most common form of investigative consumer report is an employment history or verification. These searches will be conducted by HIREASE LLC DBA ACCURATENOW, PO Box 2559, Southern Pines, NC 28388, Voice: [PHONE REDACTED], accuratenow.com. The scope of this disclosure is all-encompassing, however, allowing the Company to obtain from any outside organization all manner of consumer reports throughout the course of your employment to the extent permitted by law. ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK I acknowledge receipt of the separate document entitled DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by the City of Laramie at any time after receipt of this authorization and throughout my employment, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by HIREASE LLC DBA ACCURATENOW, PO Box 2559, Southern Pines, NC 28388, Voice: 866-680- 3596, accuratenow.com and/or Employer itself. I agree that a facsimile electronic or photographic copy of this Authorization shall be as valid as the original. IDENTIFYING INFORMATION FOR CONSUMER REPORTING AGENCY (PLEASE PRINT OR TYPE) Applicant Name: (First Middle Last) Current Address: (street address) Other Name Used: (like Maiden) City: State: Zip: Social Security Number: Former Address Sex: Race: City: State: Zip: Driver’s License No.: Former Address Month, Day, and Year of Birth: City: State: Zip: Educational Institution: Professional License: State Issued: Name Attended Under Degree Awarded of Attendance/Graduation License Number Issue Date Expiration Date Without this information, we will be unable to properly identify you in the event we find adverse information during the course of our background investigation. Signature: Date: