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th* Ilniv*ltlty **ndx*t* raf*r*n*e A* p*rt rf t&e sr*,I *grprxvnl prwuc ef lrr rpp*intxr*ntn *trI oulig ycu t* dircloa* ln wrlsug th* nad heNrgrcxnd xtoe*king, Tne Univ*rrity lqo-_ ary af gJs fntt *nd fiir-un*trrhndlNg af relwrxr r*c& rnd iliffi*tionr*g*

fulkxi*g:
debanne*l by a &der*tr ageney: any fsrm cf Fmfsssisnal mi*E*xs*ct *r senctian$. {1.s., that U?**: ,*st iuiioi ot surrendef; an ndr:rission cr detsrmi*ntisn profos*irn*l you haxe camrnitted research misconduct);

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*ny nourt' sr discriminetioll ys$ wer*,fo*nd .ts hnv* esmmi'tted by findings ef timirud ro sxry but nsr ndjudientivr b@ ar cdnn$imativy'Gy, ln*to*ing ty- p*on1 *i lb*r*r arnploy*r*; Any folcxy nr hsrgs$dnsnt *r discrimi*ntisu rnsds
Any hcrassrr*nt
lto eon&st' mi*dsmmnu f*r whick ys$ wcrs cnrwiEted nr pled

it*p$ disqurliff you {i'um en sngr6cm** in any ru*h *onduet r$ay nst' -in nnd af m disel*ee s$*h in&rmstis!'' of a$y appcinUrrent X ftJ Uuiv*rxiry" Horxdvar, feilurs mvske en

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cffer nf ugeuinuo#;; and sv*ilsblc *fi n nscd-ts*knnw bxni* a*ly'

thave nothing to disclose'

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ia esixeqtion rryith"ths dissl*num' would hc grounds eonfidenti*l uofuu*q*r*nt ernploymcnt' **arr*xion is kcpt

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prsvidc eatpxe*aricn nr npprrrprinre und I havs th* fuliswixlg inform*,ticn. ts *isglose {pl*ase ffich dditionslsheets if necessary)'

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Wor* Unit Tltis fonn. which y*u sht}uld rcxd uare{i:lly,'has be*n prwvided {s ysu b*eau** $e univ*rsiry rnny rsque$t & e$Rsuffirr repmt undlor investigative eonsumer rcport as those terms are defined by the Fair cretlir jso1i*'pr****enr of Reporri"e background rapor* fur *rnplcyment*r*lafed purposes. Tie universiry will t;q.# iurrn r"pon* sol*ly fur rmplaymx*t-relat*d

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Th* crnsunr repmt nndlor investigrriv* esn$$mar ruport rrill bs ubrain*d krrrr Hirn*.igltt, In*", {*Hire&isht"} losated at ?lss Main street, suite 400, lrvine, cA 9?614. They can be contacea at E00400-z?dl. The i"r"til"ii"" *ught *uf m.iuo* bur nor be iimitcd to a number of f,*utse, rush ils cr{minal eonviclisn.r*eqrd*; public r$urf ${sdsi an$ wh*n applicailn, oepar*nen* uiMnto, Vchi*lc retords, *r*dit repcrt*, and v*ritirsli$n *f highest deryec irapplieable, cunrlnr profe*xi#d ficense **rned. The infonnxtiun will br kapt in sbici ssnfidence uy itirenight and the unive*ity.

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Although uircRight mey $ot br deing c bnclcgro*nd check sn your cr*dit hict*ry, sit:sc such *redi{ r*pcrt i*fnn*atis:r is nst req,rnrtsd rvhtn **ch inftrmstifft has no ernpt*yrn*nt-rainted purp*sa, thi rxler sutlilred in *rs rair *r*dit Rspor{fng Ast, t5 {.t.s,e. $ lsslg{a}, rlx* *pply t* triminEl background cke**s *nd, up*n your r$que$r, I{iraRight sn*r aixsbss; y"- iopy oi it * 13*; y*w fil* ar tNr* tir$s sf thf rEqB63t. Als* cu rcqusst, y$lr ea:r rs**iv* u *spy *fthe " "$ui$:rsry of Your *grr* urd*r the Fair credit R.cporting Act,, prepar*d pur$ue$ is l5 u.s'c'-$ l68lg(c), nnd you have the right r0 rrgueir addltis**I iiscls*ur*s *f th* naturc and **ope of tlre inv*stigation pws$ant ts n p**dvrrs* si adveme aeiion by the university,

have rend ear*fully and snd*srand ttris Is&ns*ti-and, by my signarur* bEra,rv, sorisslrr tc t;e reles$e cf a csn$um&r nndllor in?estig*tivt cqn*urn*r repsrt, ** de&ned absve, to th* {Jniversiry lo riql*ctis$ $i& any lett*r or innic*ticln of iRterest, r*$uine' cr applicatiu* f*r emptoynent. This **nsent fixn in nriginal, fsxe*, efr*;sied or eleptsni, ,*ltt vslid fbr any repsrts that may b's ruq*sst*d bythe univ*rsiry at *ris time or in rh* Sglrsreintivs,,*

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I{STICg Tfr CALNFNRXtrA APSLICAI{TS

Under section l?86.?? sf the california civil !cd1, vou rnay in*Bect the {:{e maintained sil yr}u by Hirefi1g}rt. y*u nroy alsc sbtain a copy af this file, upon submitting proper identification and piying rhe cosr of duplication rr*ir**,iy u, njrnish, ofiices in psr$on, dwing ncrmal business hours and on re*ssn&l. n*tlq*; or yg{J may r*criv* a $rml}nry of *e file by mail. ltir*Right has trained p*rsrnncl avsilable tn explain y*ur fil* ts yilu. inctrudlng n*y cad*o infonnatisn. If ycu app*sr in per*on, ycu may be acccmpanied by one other penson.

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Lt F 0R!s*1A, r!{n{$tssfi TA Ari{Ir ff KL*$0*IA ru$tl}EffTg Sff Ly ***ordance wtlh ths lal#s sf calif*rnia, i!{innesota and oklahuma, a resident of sne of those stets$ has the rigirt to receive a free copy of his or her consurnr rcport an&br investigative consumer repart by checiing

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I wirh to rsreive a &ee cap)r *f tlre so$sufirer rspsrt snd.lcr investigative coo$u{nqr repfft sn mg ;g*r ir r*quesr*d,

PLEASE RETURN COMPLETED rORM TO OFrtC[ OF HUMAN Rf,SOURCES, ATTI{: BACKGROUND CHSCKS,520 JAMES M. f,LLIOTT BUILDTNG, UNIVSRSITY PARK, PN I6S0z; FAX 8I.I-86g-+iAr;

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