Initial Background Waivers – The Gumshoe Group!

Google_Workspace_3 – Initial Gumshoe Waivers

Before we can start your pre-employment background, we need you to complete the initial waivers. These waivers include E-Sign Consent, Release of Information Authorization, Waiver of Right to Review Background, Discovery of Criminal Activity Advisement, False Statement Advisement, Fair Credit Reporting Act Advisement, Notice of Intent to Use Credit Data, Prison Rape Elimination Act of 2003, Release of Liability, Authorization for Use of Photograph, Mandatory Reporter Notice (Elder/Dependent Adult), Mandatory Reporter Notice (Child Abuse), and Use of Public Records (Civil Code 1786.29(b)). You will receive a copy of these documents once you complete this process.

This field is hidden when viewing the form

a_case_number

This field is hidden when viewing the form

Unique ID

This field is hidden when viewing the form

a_case_folder

This field is hidden when viewing the form

a_case_file

This field is hidden when viewing the form

a_case_investigator_1_file

This field is hidden when viewing the form

o_spare_1

This field is hidden when viewing the form

o_spare_2

This field is hidden when viewing the form

o_spare_3

This field is hidden when viewing the form

o_spare_4

This field is hidden when viewing the form

o_spare_5

This field is hidden when viewing the form

Workflow Parent Entry ID

This field is hidden when viewing the form

Workflow Parent Entry Url

This field is hidden when viewing the form

Investigator Email Address

This field is hidden when viewing the form

Agency

E‐SIGN DISCLOSURE AND CONSENT ADDENDUM

Please read the document in full and then digitally sign below.

Candidate Name(Required)

First Last

Candidate Email(Required)

E-Sign Consent(Required)

I consent to use e-sign for communications.

I DO NOT consent to use e-sign for communications

Candidate Signature(Required)

Date(Required)

MM slash DD slash YYYY

WAIVER AND RELEASE OF INFORMATION

Please read the document in full and then digitally sign below.

Candidate Signature(Required)

Date(Required)

MM slash DD slash YYYY

RELEASE AND WAIVER

Please read the document in full and then digitally sign below.

Candidate Signature(Required)

Date(Required)

MM slash DD slash YYYY

ADVISEMENT REGARDING DISCOVERY OF CRIMINAL ACTIVITY

Please read the document in full and then digitally sign below.

Candidate Signature(Required)

Date(Required)

MM slash DD slash YYYY

ADVISEMENT TO APPLICANTS REGARDING FALSE STATEMENTS

Please read the document in full and then digitally sign below.

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.

Candidate Signature(Required)

Date(Required)

MM slash DD slash YYYY

FAIR CREDIT REPORTING ACT DISCLOSURE & AUTHORIZATION DISCLOSURE

Please read the document in full and then digitally sign below.

Candidate Signature(Required)

Date(Required)

MM slash DD slash YYYY

ADVISEMENT TO CANDIDATE REGARDING CREDIT INFORMATION FOR EMPLOYMENT PURPOSES

Please read the document in full and then digitally sign below.

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.

Candidate Signature(Required)

Date(Required)

MM slash DD slash YYYY

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

Please read the document in full and then digitally sign below.

Candidate Signature(Required)

Date(Required)

MM slash DD slash YYYY

SECTION 1051 LABOR CODE WAIVER

Please read the document in full and then digitally sign below.

Candidate Signature(Required)

Date(Required)

MM slash DD slash YYYY

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

Please read the document in full and then digitally sign below.

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.

Candidate Signature(Required)

Date(Required)

MM slash DD slash YYYY

Statement of Knowledge and Compliance with Penal Code Section 11166.5

Please read the document in full and then digitally sign below.

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.

Candidate Signature(Required)

Date(Required)

MM slash DD slash YYYY

DISCLOSURE AND ELECTION FORM TO RECEIVE/NOT RECEIVE PUBLIC RECORDS

Please read the document in full and then digitally sign below.

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.

Candidate Signature(Required)

Date(Required)

MM slash DD slash YYYY

Development Department (EDD) to release a copy of the following records pertaining to myself:

Unemployment Insurance Payment History

Disability Insurance Payment History

Current Base Wage Period wages as reported by my employers

Archived wages by quarter as reported by my employers

This field is hidden when viewing the form

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

PDF Preview

Candidate Social Security Number(Required)

Candidate Signature(Required)

Date(Required)

MM slash DD slash YYYY

Have you served in the military or as a reserve or national guard?(Required)

Yes

Information Needed to Locate Records

Name Used During Service(Required)

First Middle Last

Social Security No.(Required)

Date of Birth(Required)

Place of Birth

City State / Province / Region Country

Service, Past and Present

(For an effective records search, it is important that ALL service be shown below.)

Active

Please enter the Active service record

Branch of Service	Date Entered	Date Released	Is this person enlisted?	Is or was this person an officer?	If known, enter the person’s service number	Actions

There are no Service Records.

Maximum number of service records reached.

Reserve

Please enter the Reserve service record

Branch of Service	Date Entered	Date Released	Is or was this person an officer?	Is this person enlisted?	If known, enter the person’s service number	Actions

There are no Service Records.

Maximum number of service records reached.

National Guard

Please enter the National Guard service record

Branch of Service	Date Entered	Date Released	Is or was this person an officer?	Is this person enlisted?	If known, enter the person’s service number	Actions

There are no Service Records.

Maximum number of service records reached.

Please List Last Four Duty Stations, If Known:

Duty Station 1

Duty Station 2

Duty Station 3

Duty Station 4

Did this Person Retire from Military Service?(Required)

Yes

This field is hidden when viewing the form

Return Address and Signature

This field is hidden when viewing the form

Company Name

This field is hidden when viewing the form

Address

Street Address Apt. # City State / Province / Region ZIP / Postal Code Country

This field is hidden when viewing the form

Daytime Phone

This field is hidden when viewing the form

Fax Number

This field is hidden when viewing the form

Email Address

Authorization Signature

(See items 2a or 3a on the accompanying instructions sheet. Without the Authorization Signature of the veteran, next-of-kin of deceased veteran, veteran’s legal guardian, authorized government agent, or other authorized representative, only limited information can be released unless the request is archival.)

Declaration(Required)

I declare (or certify,verify, or state) under penalty of perjury under the laws of the United States of America that the information in this Section 3 is true and correct and that I authorize the release of the requested information.

Signature(Required)

Date(Required)

MM slash DD slash YYYY

PDF Preview