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Click here or scroll down to respond to this candidateSagineI do not have a Middle Name / InitialDonatOther Candidate's Name PHONE NUMBER AVAILABLEPrimary EMAIL AVAILABLECandidate's Name
91 Florence AveIrvington, NJ 07111-13432021-Mar-01 - Current2004-Aug-21SSN: XXX-XX-XXXXIn which country are you completing this process? Candidate's Name , what is your state of residence? New jersey Contact InformationPhone NumbersEmail AddressesCurrent AddressPersonal InformationLocation InfoConsent to Use of Electronic Records and Signatures You have the opportunity to complete and sign documents, as well as receive notices and other documents related to your employment candidacy and background check, in electronic rather than paper form. To agree to these uses of electronic documents and signatures, and to sign this document with the same effect as physically signing your name, click the "Sign" button at the bottom of this page after reviewing the information below. In order to sign, complete and receive documents electronically you will need the following: A personal e-mail addressA computer or other device with standard e-mail software Current version of Chrome, Firefox, Edge or Safari A connection to the internetA printer if you want to print paper copiesAlternatively, you may choose to use and sign paper versions of documents related to your application, including the background check. To do so, please contact the company representative who sent you this request. By clicking "Sign" below, you consent to electronically sign, complete and receive documents relating to your application and background check during both this session and any future sessions relating to your application. Additionally, you consent to electronically receive: communications relating to your application and associated background check, including requests for additional information; notices of actions taken on your application required by law, (including the Fair Credit Reporting Act for US consumers); and notices of your rights under applicable laws. Your consent applies to documents completed, signed or provided via this website, as well as to documents transmitted via email.You have the right to withdraw your consent at any time by calling Sterling on 1-800-943-2589 (in the US only), emailing EMAIL AVAILABLE, or writing to: Sterling (ESign Center), 6150 Oak Tree Boulevard, Suite 490, Independence, OH, 44131 USA. If you withdraw consent, you will no longer have the ability to sign documents electronically and to receive disclosures and other documents electronically. Your withdrawal of consent is prospective only and will become effective after we have had a reasonable opportunity to act upon it. After withdrawing your consent, please also contact the company representative who sent you this request to make arrangements to receive paper copies of documents and communications.If your contact information changes, please call Sterling on PHONE NUMBER AVAILABLE (in the US only), email: EMAIL AVAILABLE, or write to: Sterling (ESign Center), 6150 Oak Tree Boulevard, Suite 490, Independence, OH, 44131 USA.After consenting, you can obtain copies of documents and communications relating to your candidacy and associated background check by: (1) using your browser to print paper copies or save electronic copies of documents or screens during this session and future sessions; (2) selecting one of the options on the Confirmation page at the end of this session; or (3) calling Sterling on PHONE NUMBER AVAILABLE (in the US only) or emailing EMAIL AVAILABLE to request that paper copies be mailed to you at no charge. I understand that by typing my name where indicated below, and then clicking on Sign, I consent to the use of electronic records and signatures in the manner described above, and the electronic storage of such documents. Type name: Sagine DonatDISCLOSURE REGARDING BACKGROUND INVESTIGATIONGirl Scouts of Northern New Jersey ("the Company") may obtain information about you from a third party consumer reporting agency for employment purposes. Thus, you may be the subject of a "consumer report" which may include information about your character, general reputation, personal characteristics, and/or mode of living. These reports may contain information regarding your criminal history, social security verification, motor vehicle records ("driving records"), verification of your education or employment history, or other background checks. The investigations will be conducted by Sterling Infosystems Inc. 6150 Oak Tree Boulevard, Suite 490, Independence, OH 44131. PHONE NUMBER AVAILABLE www.sterlingcheck.com.[End of Document]p. 1 of 1DISCLOSURE REGARDING ''INVESTIGATIVECONSUMER REPORT'' BACKGROUNDINVESTIGATIONGirl Scouts of Northern New Jersey (the ''Company'') may request an investigative consumer report about you from a third party consumer reporting agency, in connection with your employment or application for employment (including volunteer assignment(s), as applicable) and throughout your employment if you are hired or retained, as allowed by law. An ''investigative consumer report'' is a background report that includes information from personal interviews(except in California, where that term includes background reports with or without information obtained from personal interviews). The most common form of an investigative consumer report in connection with your employment is a reference check through personal interviews with sources such as your former employers and associates, and other information sources. The investigative consumer report may contain information concerning your character, general reputation, personal characteristics, or mode of living. You have the right, upon written request made within a reasonable time, to request from the Company (1) whether an investigative consumer report has been obtained about you, (2) disclosure of the nature and scope of any investigative consumer report and (3) a copy of your report. These reports will be prepared by Sterling Infosystems Inc. 6150 Oak Tree Boulevard, Suite 490, Independence, OH 44131. 1.866.338.6739 www.sterlingcheck.com.[End of Document]p. 1 of 1California, Minnesota, and Oklahoma Residents and Applicants Only: Please check the box to the left if you would like a free copy of any REPORT obtained by COMPANY from Sterling. OTHER STATE LAW NOTICESNew York residents and applicants only: Upon request, you will be informed whether or not a consumer report was requested by the Company, and if such report was requested, informed of the name and address of the consumer reporting agency that furnished the report. You have the right to inspect and receive a copy of any investigative consumer report requested by the Company by contacting the consumer reporting agency directly. By signing the Acknowledgment and Authorization for Background Investigation, you acknowledge receipt of Article 23-A of the New York Correction Law. New York City residents and applicants only: By signing the Acknowledgment and Authorization for Background Investigation, you further authorize the Company to provide you with a copy of your consumer report, the New York City Fair Chance Act Notice form, and any other documents, to the extent required by law, at the mailing address and/or email address you provide to the Company. Minnesota residents and applicants only: You have the right to submit a written request to the consumer reporting agency for a complete and accurate disclosure of the nature and scope of any consumer report the Company ordered about you. The consumer reporting agency 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.Los Angeles residents and applicants only: Please click here to receive a copy of the Notice to Applicants& Employees Fair Chance Initiative for Hiring Ordinance. San Francisco residents and applicants only: Please click here to receive a copy of the San Francisco Fair Chance Ordinance Notice.Washington State residents and applicants only: You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act.By clicking Next below, you acknowledge that you have received and understand the state law notices above, including the linked documents.Para informacin en espaol, visite www.consumerfinance.gov/learnmore o escribe a la Consumer Financial Protection Bureau, 1700 G Street NW, 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 NW, 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 adverseaction against you because of information in your credit report; you are the victim of identity theftand place a fraud alert in your file; your file containsinaccurate information as a resultof 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 from the lists these offers are based on. You may opt out with the nationwide credit bureaus at PHONE NUMBER AVAILABLEThe 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 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.States 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 affiliates b. Such affiliates that are not banks, savingsassociations, 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 banks b. State member banks, branches and agencies offoreign banks (other than federal branches, federal agencies, and Insured State Branches of ForeignBanks), commercial lending companies owned orcontrolled 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 savingsassociationsd. 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 DepositorAssistanceFederal 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 ProtectionDepartment of Transportation1200 New Jersey Avenue SEWashington, DC 205904. Creditors Subject to the Surface Transportation BoardOffice of Public Assistance, Governmental Affairs, and Compliance Surface Transportation Board395 E Street SWWashington, DC 204235. Creditors Subject to the Packers and Stockyards Act, 1921Nearest Packers and Stockyards Division RegionalOffice6. Small Business Investment Companies Associate Administrator, Office of Capital Access Candidate's Name 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 SystemFarm Credit Administration1501 Farm Credit DriveMcLean, VA 22102-50909. Retailers, Finance Companies, and All OtherCreditors Not Listed AboveFederal Trade CommissionConsumer Response Center600 Pennsylvania Avenue NWWashington, DC 20580PHONE NUMBER AVAILABLENEW YORK CORRECTION LAWARTICLE 23-ALICENSURE AND EMPLOYMENT OF PERSONS PREVIOUSLYCONVICTED OF ONE OR MORE CRIMINAL OFFENSESSection 750. Definitions.751. Applicability.752. Unfair discrimination against persons previously convicted of one or more criminal offenses prohibited. 753. Factors to be considered concerning a previous criminal conviction; presumption. 754. Written statement upon denial of license or employment. 755. Enforcement.750. Definitions. For the purposes of this article, the following terms shall have the following meanings: 1. Public agency means the state or any local subdivision thereof, or any state or local department, agency, board or commission.2. Private employer means any person, company, corporation, labor organization or association which employs ten or more persons.3. Direct relationship means that the nature of criminal conduct for which the person was convicted has a direct bearing on his fitness or ability to perform one or more of the duties or responsibilities necessarily related to the license, opportunity, or job in question.4. License means any certificate, license, permit or grant of permission required by the laws of this state, its political subdivisions or instrumentalities as a condition for the lawful practice of any occupation, employment, trade, vocation, business, or profession. Provided, however, that "license" shall not, for the purposes of this article, include any license or permit to own, possess, carry, or fire any explosive, pistol, handgun, rifle, shotgun, or other firearm.5. Employment means any occupation, vocation or employment, or any form of vocational or educational training. Provided, however, that employment shall not, for the purposes of this article, include membership in any law enforcement agency.751. Applicability. The provisions of this article shall apply to any application by any person for a license or employment at any public or private employer, who has previously been convicted of one or more criminal offenses in this state or in any other jurisdiction, and to any license or employment held by any person whose conviction of one or more criminal offenses in this state or in any other jurisdiction preceded such employment or granting of a license, except where a mandatory forfeiture, disability or bar to employment is imposed by law, and has not been removed by an executive pardon, certificate of relief from disabilities or certificate of good conduct. Nothing in this article shall be construed to affect any right an employer may have with respect to an intentional misrepresentation in connection with an application for employment made by a prospective employee or previously made by a current employee.752. Unfair discrimination against persons previously convicted of one or more criminal offenses prohibited. No application for any license or employment, and no employment or license held by an individual, to which the provisions of this article are applicable, shall be denied or acted upon adversely by reason of the individual's having been previously convicted of one or more criminal offenses, or by reason of a finding of lack of good moral character when such finding is based upon the fact that the individual has previously been convicted of one or more criminal offenses, unless:1. There is a direct relationship between one or more of the previous criminal offenses and the specific license or employment sought or held by the individual; or2. The issuance or continuation of the license or the granting or continuation of the employment would involve an unreasonable risk to property or to the safety or welfare of specific individuals or the general public.753. Factors to be considered concerning a previous criminal conviction; presumption. 1. In making a determination pursuant to section seven hundred fifty-two of this chapter, the public agency or private employer shall consider the following factors: a. The public policy of this state, as expressed in this act, to encourage the licensure and employment of persons previously convicted of one or more criminal offenses. b. The specific duties and responsibilities necessarily related to the license or employment sought or held by the person.c. The bearing, if any, the criminal offense or offenses for which the person was previously convicted will have on his fitness or ability to perform one or more such duties or responsibilities. d. The time which has elapsed since the occurrence of the criminal offense or offenses. e. The age of the person at the time of occurrence of the criminal offense or offenses. f. The seriousness of the offense or offenses.g. Any information produced by the person, or produced on his behalf, in regard to his rehabilitation and good conduct.h. The legitimate interest of the public agency or private employer in protecting property, and the safety and welfare of specific individuals or the general public. 2. In making a determination pursuant to section seven hundred fifty-two of this chapter, the public agency or private employer shall also give consideration to a certificate of relief from disabilities or a certificate of good conduct issued to the applicant, which certificate shall create a presumption of rehabilitation in regard to the offense or offenses specified therein.754. Written statement upon denial of license or employment. At the request of any person previously convicted of one or more criminal offenses who has been denied a license or employment, a public agency or private employer shall provide, within thirty days of a request, a written statement setting forth the reasons for such denial.755. Enforcement.1. In relation to actions by public agencies, the provisions of this article shall be enforceable by a proceeding brought pursuant to article seventy-eight of the civil practice law and rules. 2. In relation to actions by private employers, the provisions of this article shall be enforceable by the division of human rights pursuant to the powers and procedures set forth in article fifteen of the executive law, and, concurrently, by the New York city commission on human rights. ACKNOWLEDGMENT AND AUTHORIZATION FORBACKGROUND INVESTIGATIONI acknowledge receipt of the separate documents entitled DISCLOSURE REGARDING BACKGROUND INVESTIGATION, DISCLOSURE FOR INVESTIGATIVE CONSUMER REPORT (if applicable), A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and OTHER STATE LAW NOTICES and certify that I have read and understand those documents. I hereby authorize the obtaining of "consumer reports" and/or"investigative consumer reports" by Girl Scouts of Northern New Jersey (the "Company") at any time after receipt of this authorization and throughout my employment, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by Sterling Infosystems Inc. 6150 Oak Tree Boulevard, Suite 490, Independence, OH 44131. PHONE NUMBER AVAILABLE www.sterlingcheck.com. and/or the Company. I agree that a facsimile ("fax"), electronic or photographic copy of this Authorization shall be as valid as the original.Please Type Your Name * Sagine DonatDated (mm/dd/yyyy) * 6/7/2023For Purposes of Audit - E-SignID: 34795152, Sagine Donat, Date Signed on 6/7/2023 at 11:36 AM -04:00 |
