Middle Initial


BNY Mellon and it’s subsidiaries (“Company”) provide equal employment opportunities to all employees and applicants by establishing employment practices and terms, conditions and privileges of employment regardless of race, religion, color, sex, national origin, age, familial or marital status, ancestry, citizenship, sexual orientation, gender identity, veteran or military status, being a qualified individual with a disability, or any other factor protected by federal, state and/or local laws. This application does not constitute a promise of employment or an employment agreement.
Rev. 05/ 21/2013

Last Name:

First Name:

Consent Forms

including information about additional rights. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans. Consumer reporting agencies must correct or delete inaccurate. and insured state savings associations Federal Credit Unions CONTACT: a. • • • • • • • • States may enforce the FCRA.. insurance. DC 20549 Farm Credit Administration 1501 Farm Credit Drive McLean. Finance Companies. you may be able to sue in state or federal court. Access to your file is limited.gov/learnmore.gov/learnmore. a consumer reporting agency may continue to report information it has verified as accurate. the agency must investigate unless your dispute is frivolous. Written consent generally is not required in the trucking industry. fairness. or other business. and credit unions with total assets over $10 billion and their affiliates b. See www. You have the right to know what is in your file. branches and agencies of foreign banks (other than federal branches. incomplete or unverifiable information must be removed or corrected. federal agencies. visite www. go to www. Such affiliates that are not banks. you may have more rights under state law. Suite 3450 Houston. Creditors Subject to Surface Transportation Board 5. Box 1200 Minneapolis. However. incomplete. DC 20423 Nearest Packers and Stockyards Administration area supervisor Associate Deputy Administrator for Capital Access United State Small Business Administration 406 Third Street. For more information.5090 FTC Regional Office for region in which the creditor operates or Federal Trade Commission: Consumer Response Center – FCRA Washington. and All Other Creditors Not Listed Above . and must give you the name. For more information contact your state or local consumer protection agency or your state Attorney General. medical records. a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA. Consumer reporting agencies may not report outdated negative information.O. which may include your Social Security number. In many cases. or bankruptcies that are more than 10 years old. usually within 30 days. and rental history records). You may opt-out with the nationwide credit bureaus at 1-888-5-OPTOUT (1-888-5678688). Surface Transportation Board Department of Transportation 395 E Street SW Washington. You are entitled to a free file disclosure if: o a person has taken adverse action against you because of information in your credit report. savings associations. a consumer reporting agency may not report negative information that is more than seven years old. 8th Floor Washington. o your file contains inaccurate information as a result of fraud. commercial lending companies owned or controlled by foreign banks. To the extent not included in item 1 above: a. If a consumer reporting agency. In some mortgage transactions. Retailers. b. National Credit Union Administration Office of Consumer Protection (OCP). 1700 G Street N. Federal Land Bank Associations. In some cases.a. employer. FDIC Consumer Response Center 1100 Walnut Street. visit www.gov/learnmore for an explanation of dispute procedures.gov/learnmore for additional information. DC 20416 Securities and Exchange Commission 100F St NE Washington. MO 64106 d. or. contact: TYPE OF BUSINESS: 1. There are many types of consumer reporting agencies. and privacy of information in the files of consumer reporting agencies. You may request and obtain all the information about you in the files of a consumer reporting agency (your “file disclosure”). Brokers and Dealers 8. o you are the victim of identify theft and place a fraud alert in your file. and Production Credit Associations 9. Bureau of Consumer Financial Protection 1700 G Street NW Washington. 3. insurer. For information about your federal rights.. For more information.Para informacion en espanol. o you are unemployed but expect to apply for employment within 60 days. Washington.W. Office of the Comptroller of the Currency Customer Assistance Group 1301 McKinney Street. A Summary of Your Rights Under the Fair Credit Reporting Act The federal Fair Credit Reporting Act (FCRA) promotes the accuracy. In addition.consumerfinance. Box #11 Kansas City. SW. Division of Consumer Compliance and Outreach (DCCO) 1775 Duke Street Alexandria. Federal Intermediate Credit Banks. Inaccurate. Insured State Branches of Foreign Banks. Federal Land Banks.consumerfinance. Banks. the disclosure will be free. you will receive credit score information for free from the mortgage lender.gov/learnmore or write to: Consumer Financial Protection Bureau. VA 22102.consumerfinance. TX 77010-9050 b. National banks. and phone number of the agency that provided the information. DC 20006. Federal Reserve Consumer Help Center P. and federal branches and federal agencies of foreign banks State member banks. but you will have to pay for it. See www. You will be required to provide proper identification. A consumer reporting agency may provide information about you only to people with a valid need -usually to consider an application with a creditor. You may limit “prescreened” offers of credit and insurance you get based on information in your credit report. In most cases. DC 20552 b. o you are on public assistance.gov/leanmore o escribe a la Consumer Financial Protection Bureau. • You have the right to dispute incomplete or inaccurate information. DC 20590 Office of Proceedings. If you identify information in your file that is incomplete or inaccurate. General Counsel for Aviation Enforcement & Proceedings Department of Transportation 400 Seventh Street SW Washington. For more information. VA 22314 Asst. savings associations. go to www. landlord.consumerfinance. You may seek damages from violators. Creditors Subject to Packers and Stockyards Act 6. and report it to the consumer reporting agency. or employment – or to take another adverse action against you – must tell you. Anyone who uses a credit report or another type of consumer report to deny your application for credit. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. d. Air carriers 4. in addition to the Bureau: 2. A consumer reporting agency may not give out information about you to your employer. in some cases. and insured state branches of foreign banks). • You have the right to ask for a credit score. or credit unions also should list. or unverifiable information. Federal Trade Commission: Consumer Response Center – FCRA Washington. address. 1700 G Street N. and organizations operating under section 25 or 25A of the Federal Reserve Act Nonmember Insured Banks. The FCRA specifies those with a valid need for access.consumerfinance. DC 20580 (877) 382-4357 c. MN 55480 c. Identity theft victims and active duty military personnel have additional rights. without your written consent given to the employer. • You must be told if information in your file has been used against you. Washington DC 20552. and many states have their own consumer reporting laws. You must give your consent for reports to be provided to employers. including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories. federal savings associations.consumerfinance. 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.W. 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. or a potential employer. Here is a summary of your major rights under the FCRA. Small Business Investment Companies 7. DC 20580 (877) 382-4357 a.

or arising from. deem necessary for employment purposes. general reputation. I will receive further notice and a request for permission at any time another Investigative Consumer Report is sought for employment purposes other than for suspicion of wrongdoing or misconduct. and that an analysis of any such report by The Bank of New York Mellon ("BNY Mellon") may affect its decision whether or not to offer employment to me or to continue employment. every such government agency. any such government agency. if applicable. concerning my employment suitability and qualifications. and fully discharge. the trade name (written in full) under which the recipient conducts business and. personal characteristics. Sources of information. violence or drug-related offenses reported to The Agencies by any merchant or private sector employer where such acts occurred. (“The Agencies”) and to conduct inquiry(s) to The Agencies. I have been informed and I understand that I may obtain a copy of such report(s) and that I may dispute the accuracy or completeness of the information reported to The Employer. release. The identification of a recipient shall include the name of the recipient or. that I have read and fully understand the contents of the notice. and amounts of any checks or charges upon which is based any adverse characterization of the consumer. The following is a summary of your rights regarding the Investigative Consumer Report. the release or dissemination of any such information for such purposes. and The Agencies to disseminate such report(s) to The Employer during any period(s) while I may be employed by The Employer. I also hereby authorize and consent to The Agencies. addresses. The names. acquired solely for use in preparing an investigative consumer report and actually used for no other purpose need not be disclosed. I hereby generally consent. I further authorize and consent to the release of any information by any government agency where such conviction data/information is on file. The Agency shall also identify the recipients of any Investigative Consumer Report on you that the Agency has furnished for either of the following purposes: 1) For employment or insurance purposes within the three-year period preceding the request. telephone numbers. and any such Company or Present/Former Employer or Credit Bureau(s). every such Company(s) and/or Present/Former Employer(s) or credit bureau(s) from and against any and all liability with respect to. The Agencies. and mode of living. [Note for California applicants and employees. to issue such reports in response to The Employer’s inquiry(s). The Bank of New York Mellon ("BNY Mellon").] I understand. or any Company or Present/Former Employer where such incident(s) or credit transaction occurred.Fair Credit Reporting Act Consent and Authorization Request Please read the following paragraphs and indicate your understanding.O. . insurance fraud. consent and agree that my employment and/or retention or promotion may be determined. an Investigative Consumer Report on me for employment purposes. I hereby authorize and consent to The Employer to make further like inquiries to The Agencies as The Employer may. (2) For any other purpose within the three-year period preceding the request. and websites of the Agencies are: Lexis Nexis Screening Solutions Consumer Center P. original payees. other than public records and records from databases available for sale. from time to time. (III) any credit bureau reports and (IV) for California applicants and employees my character. I hereby authorize and consent to The Bank of New York Mellon ("BNY Mellon") (or “The Employer”) to order a Consumer Report from one or more consumer reporting agencies. The Agency shall also disclose the dates. GA 30348 (800) 845-6004 To the full extent permitted by law. Upon request and proper identification you have the right to visually inspect all files maintained by the Agency at the time of the request about you. credit card fraud. retail theft. consent and authorization by completing the requested information. I acknowledge I have received a separate notice informing me that The Bank of New York Mellon ("BNY Mellon") may obtain a consumer report and for California applicants and employees. based on the report(s) issued to The Employer by The Agencies. (II) any incidents of employment dishonesty or any other employment-related act(s) of dishonesty. to include but not be limited to (I) any public record data/information of any criminal convictions. included in the file at the time of the disclosure. in whole or in part. upon your request the address and telephone number of the recipient. Box 105108 Atlanta. I waive any further notice with respect to The Employer’s inquiry(s) or with respect to the Agencies’ or such governmental agency’s or Company’s or Present/Former Employer’s or credit bureau’s dissemination of any such report(s).

Agencies complying with requests for certified mailings shall not be liable for disclosures to third parties caused by mishandling of the mail after such mailings leave the Agencies. if you make a written request. An investigative consumer reporting agency may require the consumer to furnish a written statement granting permission to the consumer reporting agency to discuss the consumer's file in such person's presence. A summary of all information contained in files on you and required to be provided by law shall be provided by telephone. for the telephone call is prepaid by or charged directly to you . . You are permitted to be accompanied by one other person of your choosing. you also acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. The Agency shall provide a written explanation of any coded information contained in files maintained on you. who shall furnish reasonable identification. Please check this box if you waive your right to get a copy of public records BNY Mellon gathers. ______________________________ Print Name _________________________________ Signature Date _____________________________________________________________________AKA(s) or Maiden Name (if applicable) California applicants or employees only: By signing above. and the toll charge.The agency shall supply files and information during normal business hours and on reasonable notice for your visual inspection if you appear in person and furnish proper identification. The Agency shall provide trained personnel to explain to you any information furnished to you pursuant to the law. with proper identification for telephone disclosure. This written explanation shall be distributed whenever a file is provided to a consumer for visual inspection as required under the 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. A copy of your file shall also be available for a fee not to exceed the actual costs of duplication services or by certified mail.to verify your identity. for copies to be sent to a specified addressee. if any. if you have made a written request. with proper identification.

reports pertaining to my previous work experience. military record. In addition. I also understand and Initials agree that if I am hired by the Company. lockers. APPLICANT’S PRINTED NAME:_____________________________________________________________ APPLICANT’S SIGNATURE: ________________________________________________________________ DATE: ______________________ BNY Mellon reserves the right to modify this document at any time. I understand that employment agreements may only be entered into with the prior written approval of the CEO. equipment and company vehicles assigned to me. I may have access to confidential information about the Company.PLEASE READ AND INITIAL THE FOLLOWING STATEMENTS: I (Applicant) understand and agree that: ________ All information supplied by me on this Application for Employment or contained in any other documents submitted by me in connection with this Initials Application. is complete and accurate. reason for leaving and length of service with previous employers. if hired. its agents or representatives. ________ I agree to comply with the standards of conduct set forth in the Company’s Code of Conduct and the Corporate Policy Directory (“CPD”). work areas. to obtain verification of my Initials educational background. lockers. ________ I also agree that. I understand further that this obligation continues even after my employment ends. from time to time during the employment relationship. ________ In connection with this Application for Employment. I also understand that nothing contained in this Application for Employment or any other Company document is intended to create or creates any contractual obligation on the part of the Company. work areas. and I confirm that I am able to provide such proof within three business days of my employment. except as may be required by law. its customers. if any. including background and credit checks. ________ I understand and agree that desks. to submit samples of Initials my fingerprints to the Company’s Corporate Security Division so that they may ascertain whether or not I will be able to be covered by the bond. if at any time during my employment the Company requires me to obtain any registration and/or license which I do not already Initials possess. I authorize the Company. I also agree to maintain any registration and/or license in good standing. and in accordance with the Immigration Reform & Control Act of 1986 (“IRCA”). HUMAN RESOURCES INTERVIEWER:_________________________________________________________ DATE: _____________________ . meaning that either I or the Company may terminate our relationship at any time. for any reason or no reason. including but not limited to information relating to base salary. ________ Finally. and any other background information the Company deems necessary. during the mandatory pre-employment/post offer drug testing process or random drug testing or drug testing that may be conducted upon reasonable suspicion during my employment. inaccurate or omits material information. I will obtain such registration and/or license within the time required by the Company. and its business and I agree to Initials hold such information confidential and not to disclose it to anyone outside the Company. computers. I hereby release from liability all persons or entities supplying or collecting information authorized in this paragraph. as a condition of employment. equipment and company vehicles assigned to me are Initials Company property and that I have no express or implied right to privacy with respect to the use of such items and equipment and that I will be required to permit searches of my desks. my status will be that of an employee at will. ________ As a further condition of employment. ________ I also understand that. work stations. non-competition or confidentiality clauses or any other agreement that may affect my Initials ability to perform my job with the Company. I understand that such background and credit checks may be undertaken by the Company from time to time during the employment relationship. I test positive for the presence of controlled substances or unlawful drugs or the abuse of a lawful substance. computers. ________ I understand that it is a policy of the Company to operate a drug-free workplace. I acknowledge that my Application may be rejected or my employment may be terminated if such information is incomplete. with or without advance notice . work stations. the Company may request that I be re-fingerprinted and I agree to such re-fingerprinting as a condition of continued employment. I will be required to Initials provide satisfactory proof of citizenship or legal authorization to work in the United States. Initials ________ I affirm that I am not bound by any restrictive covenants. ________ I understand that work schedules may be changed at any time in accordance with business needs and I understand and agree that I may be Initials required to work overtime and/or an alternative work schedule. I understand that my application may be rejected or my Initials employment terminated if. I understand that. job title. ________ I understand that all individuals employed by the Company must be bonded and I agree.

Sign up to vote on this title
UsefulNot useful