Disclosure and Authorization Form


DISCLOSURE AND AUTHORIZATION FORM

DISCLOSURE AND AUTHORIZATION REGARDING BACKGROUND INVESTIGATION FOR EMPLOYMENT PURPOSES

Disclosure

MILAM TRANSPORT, LLC  (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).

HireRight, LLC ("HireRight") will prepare or assemble the background reports for the Company. HireRight is located and can be contacted at 3349 Michelson Drive, Suite 150, Irvine, CA 92612, (800) 400-2761, www.hireright.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

I, hereby authorize Company to obtain the consumer reports described above about me.

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Signed by Marvin Mendoza
Signed On: July 18, 2020

Signature Certificate
Document name: Disclosure and Authorization Form
lock iconUnique Document ID: 083e8ba978ce0bd4d451056502f08f73c29bc8bd
Timestamp Audit
July 17, 2020 9:26 pm ESTDisclosure and Authorization Form Uploaded by Marvin Mendoza - accounting@milamtrans.com IP 173.168.186.65