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Profile Photo and Drivers License

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  • Bust photo (passport style, not a photo of your passport)
  • Image stored in JPG file format
  • No text or date on photo itself
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Drivers License

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Look Up Your NPN | NIPR
Look Up Your NPN | NIPR

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Experience

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Carrier Experience

 
 

Authorization Forms

NOTICE OF INTENT TO OBTAIN CONSUMER REPORTS AND AUTHORIZATION (Fair Credit Reporting Act)

Allcat Claims Service LLC (the “Company”) will procure a consumer report and/or investigative consumer report on you in connection with your application for employment, volunteer service, or a contracted position, including promotion or retention as an employee, volunteer or independent contractor, as applicable.

Sterling Infosystems, Inc. (“Sterling Talent Solutions”), a consumer reporting agency, will obtain the report for the Company. Further information regarding Sterling Talent Solutions, including its privacy policy, may be found online at www.sterlingtalentsolutions.com. Sterling Talent Solutions is located at 19910 North Creek Parkway, Suite 200, Bothell, WA98011, and can be reached at (877) 982-9888.

The report may contain information bearing on your character, general reputation, personal characteristics, mode of living and/or credit standing. The information that may be included in your report include: social security number trace, authorization to work checks, criminal records checks, civil record checks, financial information and credit checks (Experian U.S. Credit), federal record checks, public court records checks, driving records checks, drug tests, physical tests, educational records checks, employment history verification, references checks, sanction, licensing and certification checks. The information contained in the report will be obtained from private and/or public record sources, including sources identified by you in your job application or through interviews or correspondence with your past or present coworkers, neighbors, friends, associates, current or former employers, educational institutions or other acquaintances. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report from the Company.

AUTHORIZATION AND RELEASE FOR BACKGROUND CHECK

I have carefully read and understand the separate background check disclosure document and the below authorization form. I have received a copy of the “Summary of Your Rights Under the Fair Credit Reporting Act” and any applicable state or local notices of rights provided with these documents .I have had the opportunity to review my rights. By my signature below, I consent to the preparation of background reports by Sterling Talent Solutions, and to the release of such reports to the Company and its designated representatives for the purpose of assisting the Company in making a determination as to my eligibility for employment, promotion, retention, contract assignment or for other lawful purposes.

I understand that, to the extent allowed by law, information contained in my job application or otherwise disclosed to the Company by me before or during my employment or contract assignment, if any, may be utilized for the purpose of obtaining such consumer reports and/or investigative consumer reports about me. I understand that nothing herein shall be construed as an offer of employment or contract for services.

I hereby authorize law enforcement agencies, learning institutions (including public and private schools and universities), information service bureaus, credit bureaus, record/data repositories, courts (federal/state/local), motor vehicle record agencies, my past or present employers, the military, and other individuals or sources to furnish any and all information on me that is requested by the consumer reporting agency.

By my signature (including electronic) below, I certify the information provided on and in connection with this form is true, accurate, and complete. I agree that this form in original, faxed, photocopied or electronic form will be valid for any background reports that may be requested by or on behalf of the Company.

ALCOHOL MISUSE AND SUBSTANCE ABUSE POLICY ACKNOWLEDGEMENT AND SUMMARY FORM

I have been informed that this organization has a substance abuse and alcohol misuse policy in effect and that this policy allows the following: unannounced random testing, pre-employment, reasonable cause, post-accident, return to duty, and follow-up. I understand that complete copies of the policies are posted on the bulletin board and that I can review a complete copy of the Alcohol Misuse and Substance Abuse Policies by contacting the personnel department. I understand that it is my responsibility to read and become fully informed with regard to the alcohol misuse and substance abuse policy and the organizational drug program manager or third party administration group can answer that any questions I have concerning this policy.

I understand that as an applicant/adjuster I agree to willingly participate in the alcohol and substance drug testing program under the provisions set forth in the alcohol misuse and substance abuse policies. I also understand that these results are confidential but that results will be released to the company's Drug Program Manager, Medical Review Officer and/or their designee's. I understand that this information will otherwise be kept confidential and will not be released without my written consent or as it is otherwise permitted by the state law and drug and alcohol testing regulations.

Further, I understand that if I refuse to cooperate fully with management in its efforts to carry out the prescribed testing procedures as outlined in the alcohol and substance abuse policy or I have a reportable certified test result as prohibited by this policy I will be subject to discharge for insubordination (resistance of authority) or if as an applicant I fail to cooperate or have a reportable certified positive test result my application for employment will be denied and I will not be allowed to reapply with this organization

My signature below is given freely and without duress.

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