Application Package Form

Core - Application Package

We will need the following items along with the below documents on your interview day

Social Security Card
Driver's license or Passport
A voided check from your bank account

Form 8850 is for Veterans only.

* = Required Information

Employer: Core

Phone: 405-513-8606

Requested By:

SERVICES REQUESTED (Check all that apply)

Initial Screening Package (VA)

Renewal Screening Package (VA)

Initial Screening Package (FL)

Renewal Screening Package (FL)

In order to process your background check, please provide the following Information. Include your exact legal name and any other name(s) you may have used in the last seven (7) years.
PRINT CLEARLY IN INK OR TYPE IN ALL INFORMATION. MAKE SURE DISCLOSURE IS SIGNED ABOVE.

First Name *

Middle Name

Last Name *

Social Security Number *

Birth Date *

Current Address *

City *

State *

Zip *

Driver's License #

State

Other Names Used (previous 7 years only)

Please provide City and County Information for your residence covering a period of seven (7) years, beginning with your most current address.

City

County

State

Zip

From

City

County

State

Zip

From

City

County

State

Zip

From

City

County

State

Zip

From

City

County

State

Zip

From

*This information will be used for background screening purposes only and will not be us e d as hiring criteria.

[Employer Note : If you do business in Utah, you cannot ask for DOB, driver's license, or SSN until either a confidential offer of employment or at the time the background report will be run.]

Please note: These sample documents should NOT be construed as legal advice, guidance or counsel. Employers should consult their own attorney about their compliance responsibilities under the FCR4 and applicable state law. Core expressly disclaims any warranties or responsibility or damages associated with or arising out of information provided.

DRIVER/APPLICANT DISCLOSURE AND AUTHORIZATION
(IMPORTANT PLEASE READ CAREFULLY BEFORE SIGNING AUTHORIZATION)

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

Core ("the Company") may obtain information about you from a consumer reporting agency for employment purposes. 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. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment is an investigation into your criminal background history, education and/or employment history conducted by Core, 1940 NW 164, Suite C Edmond, OK 73013, 405-513-8606, or another outside organization. The scope of this notice and authorization is all-encompassing, however, allowing the Company to obtain from any outside organization all manner of consumer reports and investigative consumer reports how and throughout the course of your employment to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report.

New York applicants or employees only: You have the right to inspect and receive a copy of any investigative consumer report requested by [Employer] by contacting the consumer reporting agency identified above directly,

ACKNOWLEDGMENT AND AUTHORIZATION

I acknowledge receipt of the 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 Company 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 Core, 1940 NW 164, Suite C Edmond, OK 73013, 405-513-8606, another outside organization acting on behalf of the Company, and/or the Company itself. I agree that a facsimile ("fax"), electronic or photographic copy of this Authorization shall be as valid as the authorize both the employer and Core to have access to the above referenced information.

Minnesota and Oklahoma applicants or employees only: Please check this box if you would like to receive a copy of a consumer report if one is obtained by the Company.

California applicants or employees only: By signing below, you also acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check this box if you would like to receive a copy of an investigative consumer report or consumer credit report at no charge if one is obtained by the Company whenever you have a right to receive such a copy under California law.

Signature *

Date *

(if under 18)Guardian Signature

*This information will be used for background screening purposes only.

Employment Application

APPLICANT INFORMATION

Date *

Last Name *

First Name *

M. I.

Street Address *

Apartment/Unit # *

City *

State *

Zip *

Email *

Phone Number *

Date Available

Social Security No.

Desired Salary

Position Applied for *

Are you a citizen of the United States?

YES

Are you authorized to work in the U.S.?

YES

Have you ever worked for this company?

YES

When

Have you ever been convicted of a felony?

YES

Expalin

NOTICE:
Core conducts drug screens, credit and background checks of applicants who've accepted employment or internship offers. During the routine background investigation, we will obtain information (a ''Consumer Report”) about your credit history, as permitted, as well as other information about your personal character.

EDUCATION

High School

Address

From

Did you graduate?

YES

Degree

College

Address

From

Did you graduate?

YES

Degree

Other

Address

From

Did you graduate?

YES

Degree

REFERENCES

Please list three professional references.

Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

PREVIOUS EMPLOYMENT

Company

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

From

Reason for Leaving

May we contact your previous supervisor for a reference?

YES

Company

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

From

Reason for Leaving

May we contact your previous supervisor for a reference?

YES

Company

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

From

Reason for Leaving

May we contact your previous supervisor for a reference?

YES

MILITARY SERVICE

Branch

From

Rank at Discharge

Type of Discharge

If other than honorable, explain

DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature *

Date

Authorization for Direct Deposit

I authorize to deposit my pay automatically to the account(s) indicated below and, if necessary, to adjust or reverse a deposit for any payroll entry made to my account in error. This authorization will remain in effect until I cancel it in writing and in such time as to afford a reasonable opportunity to act on it.

Name on bank account

Bank account number

Checking

Savings

Bank routing number

Amount

or entire paycheck

*Balance of pay to:

Manual (paper check)

Account described below

*Note: Split payments are not available for contractors

Name on bank account

Bank account number

Checking

Savings

Bank routing number

Important: Please attach a voided check for each bank account to which funds should be deposited.

Attach Check

Employee/Contractor Signature *

Date

Payers: Do not send this form with your Direct Deposit enrollment. Keep for your records.