Disclosure Regarding Employment Background Report

DISH ONE Satellite ("COMPANY") may obtain from Sterling InfoSystems, Inc. ("STERLING TALENT SOLUTIONS"), 1 State Street, New York, NY 10004, (877) 424-2457, www.sterlingtalentsolutions.com, a consumer report and/or an investigative consumer report ("REPORT") that contains background information about you in connection with your employment or employment application. If you are hired, to the extent permitted by law, COMPANY may obtain from STERLING TALENT SOLUTIONS further reports throughout your employment for an employment purpose without providing further disclosure or obtaining additional consent.

The REPORT may contain information about your character, general reputation, personal characteristics and mode of living. The REPORT may include, but is not limited to, credit reports and credit history information; criminal and other public records and history; public court records (e.g., bankruptcies, tax liens and judgments); motor vehicle and driving records; educational and employment history, including professional disciplinary actions; drug/alcohol test results; and Social Security verification and address history, subject to any limitations imposed by applicable federal and state law. This information may be obtained from public record and private sources, including credit bureaus, government agencies and judicial records, former employers and educational institutions, and other sources.

If an investigative consumer REPORT is obtained, in addition to the description above, the nature and scope of any such REPORT will be employment verifications and references, or personal references.

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Authorization to Obtain Employment Background Report

I have read the Disclosure Regarding Employment Background Report provided by DISH ONE Satellite and this Authorization to Obtain Employment Background Report. By my signature below, I hereby consent to the preparation by Sterling InfoSystems, Inc. ("STERLING TALENT SOLUTIONS"), a consumer reporting agency located at 1 State Street, New York NY 10004, (877) 424-2457, www.sterlingtalentsolutions.com, of background reports regarding me and the release of such reports to the COMPANY and its designated representatives, to assist the COMPANY in making an employment decision involving me at any time after receipt of this authorization and throughout my employment, to the extent permitted by law. To this end, I hereby authorize, without reservation, any state or federal law enforcement agency or court, educational institution, motor vehicle record agency, credit bureau or other information service bureau or data repository, or employer to furnish any and all information regarding me to STERLING TALENT SOLUTIONS and/or the COMPANY itself, and authorize STERLING TALENT SOLUTIONS to provide such information to the COMPANY. I agree that a facsimile ("fax"), electronic or photographic copy of this Authorization shall be as valid as the original.

Please Type Your Name *

Dated (mm/dd/yyyy) *

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California, Maine, Massachusetts, Minnesota, New Jersey & Oklahoma Applicants Only:
I have the right to request a copy of any Report obtained by ORGANIZATION from STERLING TALENT SOLUTIONS by checking the box.(Check only if you wish to receive a copy)

State Law Notices Relating to Your Background Report

Washington State Applicants only: You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act.

New York Applicants Only: By signing the authorization, you acknowledge that you have received a copy of New York Correction Law Article 23-A. You have the right, upon written request, to be informed whether an investigative consumer REPORT was requested. If such a REPORT was requested, you will be provided with the name and address of the consumer reporting agency that prepared the REPORT and you can contact that agency to inspect or receive a copy of the REPORT.

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Para informacion en espanol, visite www.consumerfinance.gov/learnmore o escribe a la Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552. 

A Summary of Your Rights Under the Fair Credit Reporting ActThe federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to www.consumerfinance.gov/learnmore or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.

• You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment - or to take another adverse action against you - must tell you, and must give you the name, address, and phone number of the agency that provided the information.

• You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your "file disclosure"). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:

• a person has taken adverse action against you because of information in your credit report;

• you are the victim of identify theft and place a fraud alert in your file;

• your file contains inaccurate information as a result of fraud;

• you are on public assistance;

• you are unemployed but expect to apply for employment within 60 days.

In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.consumerfinance.gov/learnmore for additional information.

• You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender.

• You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See www.consumerfinance.gov/learnmore for an explanation of dispute procedures.

• Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate.

• Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old.

• Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need - usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access.

• You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to www.consumerfinance.gov/learnmore.

• You may limit "prescreened" offers of credit and insurance you get based on information in your credit report. Unsolicited "prescreened" offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-567-8688.

• You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.

• Identity theft victims and active duty military personnel have additional rights. For more information, visit www.consumerfinance.gov/learnmore

States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. For information about your federal rights, contact:

TYPE OF BUSINESS:CONTACT:

1.a. Banks, savings associations, and credit unions with total assets of over $10 billion and their affiliates.a. Consumer Financial Protection Bureau
1700 G Street NW Washington, DC 20552

b. Such affiliates that are not banks, savings associations, or credit unions also should list, in addition to the CFPB:b. Federal Trade Commission: Consumer Response Center - FCRA
Washington, DC 20580
(877) 382-4357

2. To the extent not included in item 1 above:

a. National banks, federal savings associations, and federal branches and federal agencies of foreign banksa. Office of the Comptroller of the Currency
Customer Assistance Group
1301 McKinney Street, Suite 3450
Houston, TX 77010-9050

b. State member banks, branches and agencies of foreign banks (other than federal branches, federal agencies, and Insured State Branches of Foreign Banks), commercial lending companies owned or controlled by foreign banks, and organizations operating under section 25 or 25A of the Federal Reserve Actb. Federal Reserve Consumer Help Center
P.O. Box 1200 
Minneapolis, MN 55480

c. Nonmember Insured Banks, Insured State Branches of Foreign Banks, and insured state savings associationsc. FDIC Consumer Response Center
1100 Walnut Street, Box #11
Kansas City, MO 64106

d. Federal Credit Unionsd. National Credit Union Administration
Office of Consumer Protection (OCP)
Division of Consumer Compliance and Outreach (DCCO)
1775 Duke Street
Alexandria, VA 22314

3. Air carriersAsst. General Counsel for Aviation Enforcement & Proceedings
Aviation Consumer Protection Division Department of Transportation
1200 New Jersey Avenue, SE 
Washington, DC 20590

4. Creditors Subject to Surface Transportation BoardOffice of Proceedings, Surface Transportation Board
Department of Transportation
395 E Street S.W.
Washington, DC 20423

5. Creditors Subject to Packers and Stockyards Act, 1921Nearest Packers and Stockyards Administration area supervisor

6. Small Business Investment CompaniesAssociate Deputy Administrator for Capital Access
United States Small Business Administration 
409 Third Street, SW, 8th Floor 
Washington, DC 20416

7. Brokers and DealersSecurities and Exchange Commission
100 F St NE 
Washington, DC 20549

8. Federal Land Banks, Federal Land Bank Associations, Federal Intermediate Credit Banks, and Production Credit Associations Farm Credit Administration 1501 Farm Credit Drive McLean, VA 22102-5090Farm Credit Administration 
1501 Farm Credit Drive 
McLean, VA 22102-5090

9. Retailers, Finance Companies, and All Other Creditors Not Listed AboveFTC Regional Office for region in which the creditor operates or Federal Trade Commission: Consumer Response Center - FCRA Washington, DC 20580 (877) 382-4357

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Criminal History - Self Disclosed:

HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OFFENSE THAT HAS NOT BEEN EXPUNGED, SEALED, PARDONED, ANNULLED, DISCHARGED, STATUTORILY ERADICATED OR DISMISSED UPON CONDITION OF PROBATION?

If your answer is "Yes" please read the information below to continue

If your answer is "No Record," please select the "No record to disclose" option to continue

Arizona Applicants 
Unless otherwise provided by federal or state law, a prior conviction will not be an absolute bar to employment.

California Applicants 
You are not required to disclose:

• A conviction older than seven years;

• An arrest that did not result in a conviction;

• An arrest for which pretrial diversion has been completed;

• Information about participation in a pretrial or post-trial program;

• A misdemeanor conviction for which probation was successfully complete or otherwise discharged and the case was dismissed; or

• A conviction older than two years for possession of marijuana or marijuana paraphernalia.

• Information related to an arrest, detention, processing, diversion, supervision, adjudication, or court disposition that occurred while the person was subject to the process and jurisdiction of juvenile court law.

 

San Francisco Applicants 
Do not disclose:

• Arrests that did not lead to convictions (unless there is an active pending investigation or unresolved trial);

• Diversion or deferred judgment programs;

• Expunged, dismissed or voided convictions;

• Juvenile court convictions;

• Convictions more than seven (7) years old;

• Offenses other than felonies and misdemeanors.

 

Connecticut Applicants 
You need not disclose the existence of any arrest, criminal charge or conviction records which have been erased pursuant to Conn. Gen. Stat. §§46b-146, 54-760, 54-142a, that are records pertaining to a finding of delinquency or that a child was a member of a family with service needs, an adjudication as a youthful offender, a criminal charge that has been dismissed or nulled, a criminal charge for which the person has been found not guilty or a conviction for which the person received an absolute pardon. Any person whose criminal record has been erased pursuant to these laws is deemed to have never been arrested within the meaning of the general statutes with respect to the proceedings so erased and may so swear under oath.

Hawaii Applicants 
Please limit your responses to crimes for which you were convicted within the past 10 years, excluding periods of incarceration

Massachusetts Applicants 
Do not disclose (i) an arrest, detention, or disposition regarding any violation of law in which no conviction resulted, or (ii) a first conviction for any of the following misdemeanors: drunkenness, simple assault, speeding, minor traffic violations, affray, or disturbance of the peace, or (iii) any conviction of a misdemeanor where the date of such conviction or the completion of any period of incarceration resulting therefrom, whichever date is later, occurred five or more years prior to the date of such application for employment or such request for information, unless such person has been convicted of any offense within five years immediately preceding the date of such application for employment or such request for information.

New York Applicants 
You are not required to disclose any youthful offender convictions.

Washington Applicants 
Answer "Yes" only if the conviction or release from imprisonment was within the last ten years, or related to the functions of the position for which you are applying.

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