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Click here or scroll down to respond to this candidatePremier Truck Driving SchoolStreet Address W U.S. Hwy 6Valparaiso, IN Street Address
PHONE NUMBER AVAILABLEStreet Address -10-2024 8:36:49PM CDTSignaturePersonal InformationName Yolanda GueterrezCurrent AddressCity, State/Province Zip/PostalCountryResidence 3 years or longer (If No,previous addresses shown below)YesSSN/SIN 3169Date of BirthPrimary Phone PHONE NUMBER AVAILABLECell Phone PHONE NUMBER AVAILABLEEmail EMAIL AVAILABLESignatureFull Name Yolanda GueterrezIP Address 72.26.41.225Signature Date/Time 06-10-2024 8:36 PMFederal FCRA Summary of Rights AcknowledgmentBy checking this box, I (a) acknowledgethat I have read and understand thefederal FCRA Summary of Rights andhave been given the opportunity tocopy/print the Summary of Rights and (b)agree to use an electronic signature todemonstrate my consent. An electronicsignature is as legally binding as an inksignature.YesFCRA DisclosureBy checking the box, I (a) acknowledgethat I have read and understand the aboveand also have been given the opportunityYes1to copy/print it, and (b) agree to use anelectronic signature to demonstrate myconsent. An electronic signature is aslegally binding as an ink signature.FCRA AuthorizationBy checking the box, I (a) acknowledgethat I have read and understand the aboveand also have been given the opportunityto copy/print it, and (b) agree to use anelectronic signature to demonstrate myconsent. An electronic signature is aslegally binding as an ink signature.YesEmployment Verification Acknowledgment and Release (DOT Drug and Alcohol) By checking the box, I (a) acknowledgethat I have read and understand the aboveand also have been given the opportunityto copy/print it, and (b) agree to use anelectronic signature to demonstrate myconsent. An electronic signature is aslegally binding as an ink signature.YesClearinghouse ReleaseBy checking the box, I (a) acknowledgethat I have read and understand the aboveand also have been given the opportunityto copy/print it, and (b) agree to use anelectronic signature to demonstrate myconsent. An electronic signature is aslegally binding as an ink signature.YesSummary of Rights Under 15 U.S.C. Section 1681m(a) By checking this box, I represent that Iunderstand and agree to the abovelanguage.YesINVESTIGATIVE CONSUMER REPORT DISCLOSUREBy checking this box, I represent that Iunderstand and agree to the abovelanguage.Yes2User Requested CopyUser requested a copy to be sent to thisemail address yolieh142@gmail.com.Yes3DISCLOSURE FOR CONSUMER REPORTSIn connection with your employment or owner-operator (independent contractor) application, Premier Truck Driving School may order one or more consumer report(s) (commonly known as "background reports" or "background checks") about you from one or more consumer reporting agencies. If you are hired or engaged as an owner-operator (independent contractor), additional consumer reports may be obtained in connection with and throughout your employment for employment purposes or for the legitimate business purpose of evaluating you as an owner-operator.To the extent allowed by law, the consumer reports may include information concerning your character, general reputation, personal characteristics, mode of living, drug and alcohol test results, motor vehicle records, driving records, criminal history, public court records, employment history (including names and dates of previous employers, reason for termination of employment, work experience, and accidents), social security number validation, education, licensure, or verification of other information supplied by you. Such reports may be obtained from private and public record sources, including sanctions databases, CDLIS (including but not limited to CDLIS Central Site, CDLIS Master Pointer Record data and your driver record from the jurisdiction identified in the CDLIS data, in accordance with applicable state law and the Driver Privacy Protection Act), former employers, public court records, and federal, state, and other government agencies that maintain such records. Printed Name:Yolanda GueterrezSocial Security #:3169Signed Date: 06-10-2024Yolanda GueterrezPHONE NUMBER AVAILABLE4AUTHORIZATION FOR CONSUMER REPORTSI authorize Premier Truck Driving School to obtain one or more consumer report(s) or investigative consumer report(s) about me. If hired or engaged as an owner-operator (independent contractor), I understand this authorization shall remain on file and shall serve as ongoing authorization for additional consumer reports or investigative consumer reports to be obtained from any consumer reporting agency at any time during my employment or contract period without asking me for authorization again. Printed Name:Yolanda GueterrezSocial Security #:3169Signed Date: 06-10-2024Yolanda GueterrezPHONE NUMBER AVAILABLE5Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol ClearinghouseI hereby provide consent to Premier Truck Driving School to conduct a limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse. I understand this consent shall remain on file and shall serve as ongoing consent for Premier Truck Driving School to conduct multiple limited queries of the Clearinghouse at any time during my employment or contract period without asking me for additional consent. I understand that if I refuse to provide consent for Premier Truck Driving School to conduct a limited query of the Clearinghouse, Premier Truck Driving School is required to prohibit me from performing safety-sensitive functions, including operating a commercial motor vehicle.I understand that if the limited query conducted by Premier Truck Driving School indicates that drug or alcohol information exists about me in the Clearinghouse, the FMCSA will not disclose that information to Premier Truck Driving School unless I give additional specific consent within the Clearinghouse. However, I understand that Premier Truck Driving School will be required to conduct a full query of the Clearinghouse within 24 hours after a limited query indicates that drug or alcohol information exists and that if I do not grant consent within the Clearinghouse for that full query I will be removed from performing safety-sensitive functions, including operating a commercial motor vehicle.06-10-2024Yolanda Gueterrez Date6Summary of Rights Under 15 U.S.C. Section 1681m(a) You are hereby provided a summary of the following provisions of the Fair Credit Reporting Act, 15 U.S.C. 1681m(a): The following consumer reporting agencies will prepare the background report / consumer report for Premier Truck Driving School ('Company'):Tenstreet120 W. 3rd StreetTulsa, OK 74103Phone: PHONE NUMBER AVAILABLEEmail: EMAIL AVAILABLEWeb: http://www.tenstreet.com/drivers/HireRight, LLCAttn: Consumers Dept.14002 E 21st StreetSuite 1200Tulsa, OK 74134Phone: PHONE NUMBER AVAILABLEFax: PHONE NUMBER AVAILABLEE-mail: EMAIL AVAILABLEWeb: http://www.hireright.com/applicantsiiX1716 Briarcrest DriveSuite 200Bryan, TX 77802Phone: PHONE NUMBER AVAILABLE, Option 6Web: https://www.verisk.com/iix/support/fcra-information/ AsurintCompliance DeptPO Box 14730Cleveland, Ohio 44114Phone: PHONE NUMBER AVAILABLEEmail: EMAIL AVAILABLEWeb: https://www.asurint.com/candidatesDriverIQ4500 S 129th E Ave, Suite 127Tulsa, OK 74134Phone: PHONE NUMBER AVAILABLEEmail: EMAIL AVAILABLEWeb: https://www.cisive.com/dispute-a-background-report SupervisionPO Box 21636Saint Paul, MN 55121Phone: PHONE NUMBER AVAILABLECustomer Support: PHONE NUMBER AVAILABLEExplore Information Services, LLCPO Box 21636Saint Paul, MN 55121Phone: PHONE NUMBER AVAILABLE (toll free) Email: EMAIL AVAILABLE The Work NumberEquifax Workforce SolutionsAttn: Dispute3470 Rider Trail SouthEarth City, MO 63045Phone: PHONE NUMBER AVAILABLE7Samba SafetyP.O. Box 92890Albuquerque, NM 87199Fax: PHONE NUMBER AVAILABLEWeb: https://www.safetyholdingsinc.com/consumer-dispute-instructions/ For Clearinghouse:U.S. Federal Motor Carrier Safety Administration, of the Department of Transportation, ("FMCSA-DOT") 1200 New Jersey Avenue SEWashington, DC 20590Phone: PHONE NUMBER AVAILABLE, TTY PHONE NUMBER AVAILABLEhttps://dataqs.fmcsa.dot.gov/Default.aspxFor Pre-Employment Screening Program (PSP):U.S. Federal Motor Carrier Safety Administration, of the Department of Transportation, ("FMCSA-DOT") 1200 New Jersey Avenue SEWashington, DC 20590Phone: PHONE NUMBER AVAILABLE, TTY PHONE NUMBER AVAILABLEhttps://dataqs.fmcsa.dot.gov/Default.aspxNo consumer reporting agency utilized by the Company makes adverse decisions relating to your employment or contract relationship and no consumer reporting agency utilized by the Company is able to provide any specific reasons to you why an adverse decision relating to your employment or contract relationship may be taken or was taken based on a consumer report.15 U.S.C. 1681j provides for the right to obtain a free copy of a consumer report on you from the consumer reporting agency which prepared your background report, under various circumstances, including but not limited to where you receive notice that an adverse action has been taken toward you based on the consumer report. In that instance, Section 1681j provides a right to a free copy of the report provided that you make the request within 60 days of the date that you received notice of the adverse action.15 U.S.C. 1681i provides for the right to dispute, with a consumer reporting agency the accuracy or completeness of any information in a consumer report furnished by the agency.Printed Name:Yolanda GueterrezSocial Security #:3169Signed Date: 06-10-2024Yolanda GueterrezPHONE NUMBER AVAILABLE8INVESTIGATIVE CONSUMER REPORT DISCLOSUREPremier Truck Driving School ("Company") will order an 'investigative consumer report' concerning you for employment purposes or, if you are an owner-operator (independent contractor), for the legitimate business purpose of evaluating your suitability for an independent contractor engagement pursuant to your written instructions. An 'investigative consumer report' is defined as a consumer report or portion thereof in which information on a consumer's character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with neighbors, friends, or associates of the consumer reported on or with others with whom he is acquainted or who may have knowledge concerning any such items of information.The investigative consumer report the Company will order concerning you will contain information concerning your character, general reputation, personal characteristics, and mode of living, obtained through personal interviews. You have the right to request the additional disclosures provided for under the Fair Credit Reporting Act, 15 U.S.C. 1681d(b), which reads as follows:Any person who procures or causes to be prepared an investigative consumer report on any consumer shall, upon written request made by the consumer within a reasonable period of time after the receipt by him of the disclosure required by subsection (a)(1) of this section, make a complete and accurate disclosure of the nature and scope of the investigation requested. This disclosure shall be made in a writing mailed, or otherwise delivered, to the consumer not later than five days after the date on which the request for such disclosure was received from the consumer or such report was first requested, whichever is the later. At present, the specific 'nature and scope' of the investigative consumer report the Company may request is as follows: Employment Verifications, Motor Vehicle Reports, CDLIS, Criminal Records, and PSP. The report(s) will be requested from the following: Tenstreet120 W. 3rd StreetTulsa, OK 74103Phone: PHONE NUMBER AVAILABLEEmail: EMAIL AVAILABLEWeb: http://www.tenstreet.com/drivers/HireRight, LLCAttn: Consumers Dept.14002 E 21st StreetSuite 1200Tulsa, OK 74134Phone: PHONE NUMBER AVAILABLEFax: PHONE NUMBER AVAILABLEE-mail: EMAIL AVAILABLEWeb: http://www.hireright.com/applicantsiiX1716 Briarcrest DriveSuite 200Bryan, TX 77802Phone: PHONE NUMBER AVAILABLE, Option 6Web: https://www.verisk.com/iix/support/fcra-information/ AsurintCompliance DeptPO Box 14730Cleveland, Ohio 44114Phone: PHONE NUMBER AVAILABLEEmail: EMAIL AVAILABLEWeb: https://www.asurint.com/candidatesDriverIQ4500 S 129th E Ave, Suite 127Tulsa, OK 74134Phone: PHONE NUMBER AVAILABLEEmail: EMAIL AVAILABLE9Web: https://www.cisive.com/dispute-a-background-report SupervisionPO Box 21636Saint Paul, MN 55121Phone: PHONE NUMBER AVAILABLECustomer Support: PHONE NUMBER AVAILABLEExplore Information Services, LLCPO Box 21636Saint Paul, MN 55121Phone: PHONE NUMBER AVAILABLE (toll free) Email: EMAIL AVAILABLE The Work NumberEquifax Workforce SolutionsAttn: Dispute3470 Rider Trail SouthEarth City, MO 63045Phone: PHONE NUMBER AVAILABLESamba SafetyP.O. Box 92890Albuquerque, NM 87199Fax: PHONE NUMBER AVAILABLEWeb: https://www.safetyholdingsinc.com/consumer-dispute-instructions/ For Clearinghouse:U.S. Federal Motor Carrier Safety Administration, of the Department of Transportation, ("FMCSA-DOT") 1200 New Jersey Avenue SEWashington, DC 20590Phone: PHONE NUMBER AVAILABLE, TTY PHONE NUMBER AVAILABLEhttps://dataqs.fmcsa.dot.gov/Default.aspxFor Pre-Employment Screening Program (PSP):U.S. Federal Motor Carrier Safety Administration, of the Department of Transportation, ("FMCSA-DOT") 1200 New Jersey Avenue SEWashington, DC 20590Phone: PHONE NUMBER AVAILABLE, TTY PHONE NUMBER AVAILABLEhttps://dataqs.fmcsa.dot.gov/Default.aspxYou have the right to request whether an investigative consumer report was ordered. You can also make a written request for a complete and accurate disclosure of the nature and scope of the investigation that was requested, request a copy of the report, a copy of any federal or state local notices of rights that may apply to you, or request the name, address and telephone number of the nearest unit of the consumer reporting agency designated to handle inquiries of each consumer reporting agency issuing an investigative consumer report about you, by sending a letter or email to the Company. You may also request and promptly receive from all such consumer reporting agencies free copies of any such investigative consumer reports. MARYLAND: You have the right to request additional disclosures from the Company regarding the nature and scope of the requested investigation.MASSACHUSETTS: If you contact the Company, you have the right to know whether the Company ordered an investigative consumer report about you. You also have the right to ask the CRA for a copy of any such report. MINNESOTA: You have the right in most circumstances to submit a written request to the CRA for a complete and accurate disclosure of the nature and scope of any consumer report the Company ordered about you. The CRA must provide you with this disclosure within five business days after its receipt of your request or the report was requested by the Company, whichever date is later. NEW JERSEY: You have the right to submit a request to the CRA for a copy of any investigative consumer report the Company ordered about you.NEW YORK: If you contact the Company, you have the right to know whether the Company ordered a consumer report or investigative consumer report about you. Shown above is the CRA's address and telephone number. You have the right to contact the CRA to inspect or receive a copy of any such report. A copy of Article 23-A of the Correction Law is provided in connection herewith. WASHINGTON STATE: If you submit a written request to the Company, you have the right to a complete and accurate disclosure of the nature and scope of any investigative consumer report the Company ordered about you. You are entitled to this disclosure within five business days after the date your request is received or we ordered the report, whichever is later. You also have the right to request a written summary of your rights under the Washington Fair Credit Reporting Act. 10Printed Name:Yolanda GueterrezSocial Security #:3169Signed Date: 06-10-2024Yolanda GueterrezPHONE NUMBER AVAILABLE11A Summary of Your Rights Under the Fair Credit Reporting Act 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 Act The 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 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 identity 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 form the lists these offers are based on. You may opt out with the nationwide credit bureaus at PHONE NUMBER AVAILABLE12The following FCRA right applies with respect to nationwide consumer reporting agencies: CONSUMERS HAVE THE RIGHT TO OBTAIN A SECURITY FREEZE You have a right to place a "security freeze" on your credit report, which will prohibit a consumer reporting agency from releasing information in your credit report without your express authorization. The security freeze is designed to prevent credit, loans, and services from being approved in your name without your consent. However, you should be aware that using a security freeze to take control over who gets access to the personal and financial information in your credit report may delay, interfere with, or prohibit the timely approval of any subsequent request or application you make regarding a new loan, credit, mortgage, or any other account involving the extension of credit. As an alternative to a security freeze, you have the right to place an initial or extended fraud alert on your credit file at no cost. An initial fraud alert is a 1-year alert that is placed on a consumer's credit file. Upon seeing a fraud alert display on a consumer's credit file, a business is required to take steps to verify the consumer's identity before extending new credit. If you are a victim of identity theft, you are entitled to an extended fraud alert, which is a fraud alert lasting 7 years. A security freeze does not apply to a person or entity, or its affiliates, or collection agencies acting on behalf of the person or entity, with which you have an existing account that requests information in your credit report for the purposes of reviewing or collecting the account. Reviewing the account includes activities related to account maintenance, monitoring, credit line increases, and account upgrades and enhancements.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.13States 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 affiliatesb. Such affiliates that are not banks, savings associations, or credit unions also should list, in addition to the CFPB: a. Consumer Financial Protection Bureau1700 G Street, NWWashington, DC 20552b. Federal Trade CommissionConsumer Response Center600 Pennsylvania Avenue NWWashington, DC 20580PHONE NUMBER AVAILABLE2. To the extent not included in item 1 above:a. National banks, federal savings associations, and federal branches and federal agencies of foreign banksb. 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 Act.c. Nonmember Insured Banks, Insured State Branches of Foreign Banks, and insured state savings associations d. Federal Credit Unionsa. Office of the Comptroller of the CurrencyCustomer Assistance GroupP.O. Box 53570Houston, TX 77052b. Federal Reserve Consumer Help CenterP.O. Box 1200Minneapolis, MN 55480c. Division of Depositor and Consumer ProtectionNational Center for Consumer and Depositor Assistance Federal Deposit Insurance Corporation1100 Walnut Street, Box #11Kansas City, MO 64106d. National Credit Union AdministrationOffice of Consumer Financial Protection1775 Duke StreetAlexandria, VA 223143. Air Carriers Assistant General Counsel for Office of Aviation Consumer ProtectionDepartment of Transportation1200 New Jersey Avenue, SEWashington, DC 205904. Creditors Subject to the Surface Transportation Board Office of Public Assistance, Governmental Affairs, and ComplianceSurface Transportation Board395 E Street SWWashington, DC 204235. Creditors Subject to the Packers and Stockyards Act, 1921 Nearest Packers and Stockyards Division Regional Office 6. Small Business Investment Companies Associate Administrator, Office of Capital Access United States Small Business Administration409 Third Street SW, Suite 8200Washington, DC 204167. Brokers and Dealers Securities and Exchange Commission 100 F Street NEWashington, DC 205498. Institutions that are members of the Farm Credit System Farm Credit Administration 1501 Farm Credit DriveMcLean, VA 22102-50909. Retailers, Finance Companies, and All Other Creditors Not Listed AboveFederal Trade CommissionConsumer Response Center600 Pennsylvania Avenue NWWashington, DC 20580PHONE NUMBER AVAILABLE14 |
