Equal Opportunity: All
applicants will be given equal consideration regardless of race, age, sex, physical or mental disability, sexual orientation, ancestry, pregnancy, or other medical condition, marital status, color, religion, national origin, or veteran
status.
PLEASEPRINTIN INK
HARBOR FREIGHT TOOLS
Application For Employment (NOT an offer for employment)
Note: Please print your responses and sign this application in ink. Individuals will not be considered an applicant if they exclude 1.) position applied for and date, 2.) information required by law such as authorization to work in the U.S., 3.) a complete employment history including name of employer, dates of employment, rate of pay and reason for leaving, and 4.) signature of applicant.
POSITION APPLIED FOR _________________________________________________ DATE _____________
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How Did You Learn of this Position? Newspaper |
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School |
Walk-in |
Referral (Name _______________) |
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NAME |
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TELEPHONE |
NO. 1 ( ____ ) _______________ |
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Last |
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TELEPHONE NO. 2 ( ____ ) _______________ |
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Street |
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City |
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Zip Code |
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Are you under 18? |
Yes |
No |
If Yes, do you have (or will you get) a work permit? |
Yes |
No |
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Have you been employed by this company before? Yes |
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No |
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Does your relative work here? Yes |
No |
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Are you currently employed? |
Yes |
No |
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When can you start work here? _______________ |
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Are you eligible for employment in this country? Yes |
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No |
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(Proof of eligibility will be required upon employment) |
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Can we leave a message to contact you? Yes |
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No |
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If yes, phone no. ____________________ |
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Type of Employment Desired: |
Full Time |
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Part Time |
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Temporary |
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Shift Desired: Day |
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Evening |
Night |
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Hours available to work: * |
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Mon. |
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Tue. |
Wed. |
Thur. |
Fri. |
Sat. |
Sun. |
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Are you willing to work overtime if required? |
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From |
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To |
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Yes |
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Have you been convicted of a misdemeanor or felony |
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Note: Convictions do not automatically disqualify an applicant |
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in the last seven years? |
Yes |
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No |
If yes, |
from further consideration. However, offers of employment (or the |
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please explain: |
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continued employment of newly hired employees) are contingent |
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upon criminal, background, and for some positions, credit |
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investigation findings which conform to overall company hiring |
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standards or are applicable to specific position requirements. |
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Are you able to perform the essential functions of the job applied for with or without reasonable |
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accommodation? For retail/warehouse, typical job functions in this company involve employees to bend, squat, kneel twist, work at heights |
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intermittently, pushing and pulling of materials, reaching and working above and below shoulder level, lift and carry items weighing 25 to 75 pounds, |
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work cordially with the public. For office, duties involve sitting continuously throughout the day; simple grasping, pushing, and pulling of materials; |
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stand, walk, bend squat and kneel intermittently; operate computer keyboards and 10-key calculator throughout the day; lift and carry items up to 25 |
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lbs.; read written communications and understand verbal communication over the phone. Are you able to perform? Yes |
No |
If no, please |
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explain. Attach extra sheet as necessary. Do not provide medical information. |
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* Please note: Regardless of work schedules, regular and prompt attendance is required of all employees and is an essential function of all positions.
_________________________________________________________________________________________
IN CASE OF EMERGENCY NOTIFY:
__________________________________________________________________________________________
NameAddress City State Phone
PERSONAL REFERENCE: Provide the name of one person, not related to you, whom you have known for at least one year.
_________________________________________________________________________________________________________________
Name |
address |
city |
state |
phone No. |
years known |
APPLICATION FOR EMPLOYMENT HARBOR FREIGHT TOOLS PAGE1 1/06
(If necessary, to account for for all
_________________________________ PAGE 2 1/06
EDUCATION |
(Circle the last year completed) |
Elementary School |
5 |
6 |
7 |
8 |
High School |
1 |
2 |
3 |
4 |
College |
1 |
2 |
3 |
4 |
Highest degree obtained: ______ Name of school/college: __________________
Describe other training or education:
_________________________________________________________
___________________________________________________________
Describe office/warehouse equipment you can operate (i.e. forklifts, computers, etc.)
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________
_________________________________
EMPLOYMENT HISTORY —- List your three most recent employers, starting with the most recent, including military experience. Please explain gaps in employment in the COMMENTS section below.
experience within the last 10 years, also complete SUPPLEMENT TO APPLICATION FOR EMPLOYMENT.)
Employer |
____________________________________ Telephone (_____) _________________ Dates Employed: From ____________ |
To ____________ |
Address |
______________________________________________________________________________________________________________________________ |
|
street |
city |
state |
zip code |
Job Title _______________________________________________ Starting hourly rate/salary: $__________ Final hourly rate/salary: $___________ |
Immediate Supervisor Name/Title _______________________________ Telephone # (_____) _______________ |
May we contact this person for a reference? Yes No |
Summarize the nature of your work and your duties _____________________________________________________________________________________________
______________________________________________________________________________________________________________________________________
Why did you leave this employer?
HARBOR FREIGHT TOOLS —- APPLICATION FOR EMPLOYMENT
Employer ________________________________________ Telephone (_____) _________________ Dates Employed: From ____________ |
To ___________ |
Address ______________________________________________________________________________________________________________________________ |
street |
city |
state |
zip code |
Job Title _______________________________________________ |
Starting hourly rate/salary: $__________ Final hourly rate/salary: $___________ |
Immediate Supervisor Name/Title _______________________________ Telephone # (_____) _______________ |
May we contact this person for a reference? Yes No |
Summarize the nature of your work and your duties _____________________________________________________________________________________________ |
Why did you leave this employer? |
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Employer ________________________________________ Telephone (_____) _________________ Dates Employed: From ____________ |
To ____________ |
Address ______________________________________________________________________________________________________________________________ |
street |
city |
state |
zip code |
Job Title _______________________________________________ |
Starting hourly rate/salary: $__________ Final hourly rate/salary: $___________ |
Immediate Supervisor Name/Title _______________________________ Telephone # (_____) _______________ |
May we contact this person for a reference? Yes No |
Summarize the nature of your work and your duties ______________________________________________________________________________________________
Why did you leave this employer?
COMMENTS: (Explain ALL gaps in employment)
Please read and sign:
I hereby certify that the information in this application is true and correct to the best of my knowledge and agree to have any of the information verified by this organization unless I have indicated in writing to the contrary. I authorize the references listed above, as well as other individuals who the company or the company’s agents contacts, to provide any and all information concerning my previous employment and any other pertinent information that they may have. Further, I release all parties and persons from any and all liability for any damages that may result from furnishing such information to the company as well as from the use or disclosure of such information by the company or any of its agents, employees, or representatives. I understand that any misrepresentation, falsification, or material omission of information on this application may result in my failure to receive an offer or, if I am hired, my immediate dismissal from employment. I agree to conform to the rules and standards of the company, as amended from time to time at its discretion. I agree that my employment and compensation can be terminated at will, with or without cause, and with or without notice, at any time, either at my option or at the option of the company. I understand that the company reserves the right to search all employees/persons and all parcels, packages, lunch boxes, coats, bags, containers, lockers, boxes and belongings, etc. on property controlled by the company at all times. The aforementioned right-to-search is a condition of employment. No written or oral promise of employment for a specified term is effective unless expressly set forth in a document signed by an officer of the company. I understand that I am advised not to resign current employment until after an official offer of employment by this company is extended. It is company policy to provide an environment free of discrimination or sexual harassment and if any such discrimination or harassment takes place, I will report it to a manager or a personnel representative immediately. I hereby acknowledge that I have read and fully understand the above statements, including the statement concerning company rules and the “Right-to-Search” statement.
NAME OF APPLICANT (Print) ___________________________________________________________
SIGNATURE OF APPLICANT__________________________________________________ DATE ___________________
COMPANY USE ONLY: Reviewer signature______________________ Manager signature_____________________________date______

HARBOR FREIGHT TOOLS - SUPPLEMENT TO APPLICATION FOR EMPLOYMENT
(This is a supplemental sheet which references and incorporates all information, instructions, authorizations, and provisions of Applicant's completed Application for Employment.)
EMPLOYMENT HISTORY - Continued from Application For Employment Form — Applicant: Use as many of these sheets as is necessary to account for the LAST 10 YEARS of your work experience. Please explain gaps in employ- ment in the comments section below (or on an additional/separate sheet).
APPLICANT NAME (PRINT)
Employer___________________________________Telephone ( |
)___________________________Dates Employed: From_________To________ |
Address___________________________________________________________________________________________________________________ |
street |
city |
state |
zip code |
Job Title____________________________________Starting hourly rate/salary: $________________Final hourly rate/salary $__________________
Immediate Supervisor Name/Title__________________Telephone ( )_______________May we call this person for a reference? Yes No
Summarize the nature of your work and your duties________________________________________________________________________________
__________________________________________________________________________________________________________________________
Why did you leave this employer?______________________________________________________________________________________________
Employer___________________________________Telephone ( |
)___________________________Dates Employed: From_________To________ |
Address___________________________________________________________________________________________________________________ |
street |
city |
state |
zip code |
Job Title____________________________________Starting hourly rate/salary: $________________Final hourly rate/salary $__________________
Immediate Supervisor Name/Title__________________Telephone ( )_______________May we call this person for a reference? Yes No
Summarize the nature of your work and your duties________________________________________________________________________________
__________________________________________________________________________________________________________________________
Why did you leave this employer?______________________________________________________________________________________________
Employer___________________________________Telephone ( |
)___________________________Dates Employed: From_________To________ |
Address___________________________________________________________________________________________________________________ |
street |
city |
state |
zip code |
Job Title____________________________________Starting hourly rate/salary: $________________Final hourly rate/salary $__________________
Immediate Supervisor Name/Title__________________Telephone ( )_______________May we call this person for a reference? Yes No
Summarize the nature of your work and your duties________________________________________________________________________________
__________________________________________________________________________________________________________________________
Why did you leave this employer?______________________________________________________________________________________________
COMMENTS: (Explain all gaps in employment)
_________________________________________________________________________________________________
_________________________________________________________________________________________________
THIS IS SHEET_____OF_____SHEETS SUBMITTED AS SUPPLEMENT TO APPLICATION FOR EMPLOYMENT
SIGNATURE OF APPLICANT______________________________________________DATE______________________
21719/3 |
HARBOR FREIGHT TOOLS 1/04 |
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NOTICE: This form is the property of A-Check America, Inc. No alterations to its content may be made without the prior written consent of its author. Any changes made without A-Check’s authorization are considered a breach of contract.
IMPORTANT NOTICE TO APPLICANT
A Summary of Your Rights Under the Fair Credit Reporting Act
The federal Fair Credit Reporting Act (FCRA) is designed to promote accuracy, fairness, and privacy of information if the files of every "consumer reporting agency" (CRA). Most CRA's are credit bureaus that gather and sell information about you - such as if you pay your bills on time or have filed bank- ruptcy - to creditors, employers, landlords, and other busi- nesses. You can find the complete text of the FCRA, 15 U.S.C. 1681-1681u, at the Federal Trade Commission's web site (http://www.ftc.gov). The FCRA gives you specific rights, as outlined below. You may have additional rights under state law. You may contact a state or local consumer protection agency or a state attorney general to learn those rights.
•You must be told if information in your file has been used against you. Anyone who uses information from a CRA to take action against you - such as denying an application for credit, insurance, or employment - must tell you, and give you the name, address, and phone number of the CRA that provided the consumer report.
•You can find out what is in your file. At your request, a CRA must give you the information in your file, and a list of everyone who has requested it recently. There is no charge for the report if a person has taken action against you be- cause of information supplied by the CRA, if you request the report within 60 days of receiving notice of the action you also are entitled to one free report every twelve months upon request if you certify that (1) you are unemployed and plan to seek employment within 60 days, (2) you are on welfare, or (3) your report is inaccurate due to fraud. Otherwise, a CRA may charge you up to eight dollars.
•You can dispute inaccurate information with the CRA. If you tell a CRA that your file contains inaccurate informa- tion, the CRA must investigate the items (usually within 30 days) by presenting to its information source all relevant evi- dence you submit, unless your dispute is frivolous. The source must review your evidence and report its findings to the CRA. (The source also must advise national CRA's - to which it has provided the data - of any error). The CRA must give you a written report of the investigation results in any change. If the CRA's investigation does not resolve the dispute, you may add a brief statement to your file. The CRA must normally include a summary of your statement in future reports. If an item is deleted or a dispute statement is filed, you may ask that anyone who has recently received your report be noti- fied of the change.
•Inaccurate information must be corrected or deleted. A CRA must remove or correct inaccurate or unverified information from its files, usually within 30 days after you dispute it. How- ever, the CRA is not required to remove accurate data from your file unless it is outdated (as described below) or cannot be verified. If your dispute results in any change to your re- port, the CRA cannot reinsert into your file a disputed item unless the information source verifies its accuracy and com- pleteness. In addition, the CRA must give you a written no- tice telling you it has reinserted the item. The notice must include the name, address and phone number of the informa- tion source.
•You can dispute inaccurate items with the source of the information. If you tell anyone - such as a creditor who re- ports to a CRA - that you dispute an item, they may not then report the information to a CRA without including a notice of your dispute. In addition, once you've notified the source
of the error in writing, it may not continue to report the infor- mation if it is, in fact, an error.
•Outdated information may not be reported. In most cases, a CRA may not report negative information that is more than seven years old; ten years for bankruptcies.
•Access to your file is limited. A CRA - may provide infor- mation about you only to people with a need recognized by the FCRA - usually to consider an application with a credi- tor, insurer, employer, landlord, or other business.
•Your consent is required for reports that are provided to employers, or reports that contain medical information. A CRA may not give out information about you to your em- ployer, or prospective employer, without your written con- sent. A CRA may not report medical information about you to creditors, insurers, or employers without your permission.
•You may choose to exclude your name from CRA lists for unsolicited credit and insurance offers. Creditors and insur- ers may use file information as the basis for sending you un- solicited offers of credit or insurance. Such offers must in- clude a toll-free phone number for you to call if you want your name and address removed from future lists. If you call, you must be kept off the lists for two years. If you request, complete, and return the CRA form provided for this pur- pose, you must be taken off the lists indefinitely.
•You may seek damages from violators. If a CRA, a user or (in some cases) a provider of CRA data, violates the FCRA, you may sue them in state or federal court.
The FCRA gives several different federal agencies authority to enforce the FCRA:
For Questions or Concerns Regarding: |
Please Contact: |
CRAs, creditors and others not listed below |
Federal Trade Commission |
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Consumer Response Center - FCRA |
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Washington, DC 20580 |
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202-326-3761 |
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National banks, federal branches/agencies |
Office of the Controller of the |
of foreign banks (word "National" or |
Currency/Compliance Management |
initials "N.A." appear in or after bank's |
Mail Stop 6-6 |
name) |
Washington, DC 20219 |
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800-613-6743 |
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Federal Reserve System member banks |
Federal Reserve Board |
(except national banks, and federal |
Consumer and Community Affairs |
branches/agencies of foreign banks) |
Washington, DC 20551 |
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202-452-3693 |
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Savings associations and federally |
Office of Thrift Supervision |
chartered savings banks (word "Federal" |
Consumer Programs |
or initials "F.S.B." appear in federal |
Washington, DC 20552 |
institution's name) |
800-842-6929 |
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Federal credit unions (words "Federal |
National Credit Union Admin. |
Credit Union" appear in institution's |
1775 Duke Street |
name) |
Alexandria, VA 22314 |
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703-518-6360 |
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State-chartered banks that are not |
Federal Deposit Insurance Corp. |
members of the Federal Reserve System |
Division of Compliance & |
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Consumer Affairs |
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Washington, DC 20429 |
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800-934-FDIC |
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Air, surface, or rail common carriers |
Department of Transportation |
regulated by former Civil Aeronautics |
Office of Financial Management |
Board or Interstate Commerce Commission |
Washington, DC 20590 |
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202-366-1306 |
Activities subject to the Packers and |
Department of Agriculture |
Stockyards Act, 1921 |
Office of Deputy Administrator - |
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GIPSA |
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Washington, DC 20250 |
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202-720-7051 |
NOTICE TO USERS OF CONSUMER REPORTS: OBLIGATIONS OF USERS UNDER THE FCRA
The federal Fair Credit Reporting Act (FCRA) requires that this notice be provided to inform users of consumer reports of their legal obligations. State law may impose additional requirements. The first section of this summary sets forth the responsibilities imposed by the FCRA on all users of con- sumer reports. The subsequent sections discuss the duties of users of reports that contain specific types of information, or that are used for certain purposes, and the legal consequences of violations. The FCRA, 15 U.S.C. 1681-1681u, is set forth in full at the Federal Trade Commission's Internet web site (http://www.ftc.gov).
I.OBLIGATIONS OF ALL USERS OF CONSUMER REPORTS
A. Users Must Have a Permissible Purpose
Congress has limited the use of consumer reports to protect consumer's privacy. All users must have a permissible pur- pose under the FCRA to obtain a consumer report. Section 604 of the FCRA contains a list of the permissible purposes under the law.
These are:
•As ordered by a court or a federal grand jury subpoena. Section 604(a)(1)
•As instructed by the consumer in writing.
Section 604(a)(2)
•For the extension of credit as a result of an application from a consumer, or the review or collection of a consumer's account. Section 604(a)(3)(A)
•For employment purposes, including hiring and promotion decisions, where the consumer has given written permission. Sections 604(a)(3)(B) and 604(b)
•For the underwriting of insurance as a result of an application from a consumer. Section 604(a)(3)(C)
•When there is a legitimate business need, in connection with a business transaction that is initiated by the consumer. Section 604(a)(3)(F)(i)
•To review a consumer's account to determine whether the consumer continues to meet the terms of the account. Section 604(a)(3)(F)(ii)
•To determine a consumer's eligibility for a license or other benefit granted by a governmental instrumentality required by law to consider an applicant's financial responsibility or status. Section 604(a)(3)(D)
•For use by a potential investor or servicer, or current insurer, in a valuation or assessment of the credit or prepayment risks associated with an existing credit obligation. Section 604(a)(3)(E)
•For use by state and local officials in connection with the determination of child support payments, or modifications and enforcement thereof. Sections 604(a)(4) and 604(a)(5)
In addition, creditors and insurers may obtain certain con- sumer report information for the purpose of making unsolic- ited offers of credit or insurance. The particular obligations of users of this "prescreened" information are described in Section V below.
B. Users Must Provide Certifications
Section 604(f) of the FCRA prohibits any person from ob- taining a consumer report from a consumer reporting agency (CRA) unless the person has certified to the CRA (by a gen- eral or specific certification, as appropriate) the permissible purpose(s) for which the report is being obtained and certi- fies that the report will not be used for any other purpose.
C. Users Must Notify Consumers When Adverse Actions Are Taken
The term "adverse action" is defined very broadly by Section 603 of the FCRA. "Adverse actions" include all business, credit, and employment actions affecting consumers that can be considered to have a negative impact - such as unfavor- ably changing credit or contract terms or conditions, denying or canceling, credit or insurance, offering credit on less fa- vorable terms than requested, or denying employment or pro- motion.
1. Adverse Actions Based on Information Obtained From a CRA.
If a user takes any type of adverse action that is based at least in part on information contained in a consumer report, the user is required by Section 615(a) of the FCRA to notify the consumer. The notification may be done in writing, orally, or by electronic means. It must include the following:
•The name, address, and telephone number of the CRA (including a toll-free telephone number, if it is a nationwide CRA) that provided the report.
•A statement that the CRA did not make the adverse decision and is not able to explain why the decision was made.
•A statement setting forth the consumer's right to obtain a free disclosure of the consumer's file from the CRA if the consumer requests the report within 60 days.
•A statement setting forth the consumer's right to dispute directly with the CRA the accuracy or completeness of any information provided by the CRA.
2.Adverse Actions Based on Information Obtained From Third Parties Who Are Not
Consumer Reporting Agencies:
If a person denies (or increases the charge for) credit for per- sonal, family, or household purposes based either wholly or partly upon information from a person other than a CRA, and the information is the type of consumer information cov- ered by the FCRA, Section 615(b)(1) of the FCRA requires that the user clearly and accurately disclose to the consumer his or her right to obtain disclosure of the nature of the infor- mation that was relied upon by making a written request within 60 days of notification. The user must provide the disclosure within a reasonable period of time following the consumer's written request.
3.Adverse Actions Based on Information Obtained From Affiliates:
If a person takes an adverse action involving insurance, em- ployment, or a credit transaction initiated by the consumer, based on information of the type covered by the FCRA, and this information was obtained from an entity affiliated with the user of the information by common ownership or control, Section 615(b)(2) requires the user to notify the consumer of the adverse action. The notification must inform the consumer that he or she may obtain a disclosure of the nature of the information relied upon by making a written request within 60 days of receiving the adverse action notice. If the con- sumer makes such a request, the user must disclose the na- ture of the information not later than 30 days after receiving the request. (Information that is obtained directly from an affiliated entity relating solely to its transactions or experi- ences with the consumer, and information from a consumer report obtained from an affiliate are not covered by Sction 615(b)(2).)
APPLICANT: Please read and keep this document.
Applicant Survey
Work Opportunity Tax Credit Program
Harbor Freight Tools is participating in the Work Opportunity Tax Credit program. This program is designed by the federal government to help companies hire more people into the workforce and to retain employees through federal incentives.
Your response to the questions below will help us determine if Harbor Freight Tools qualifies for this program. Any information you provide will be kept confidential and will not affect your job, wages, or taxes. Thank you in advance for your time and participation.
Check here if any of the following statements apply to you:
•I am a member of a family that has received Temporary Assistance for Needy Families (TANF) for any of the following:
During the last four years
Stopped being eligible for TANF within the last two years because of limitations on how long the benefit
.could be received
•I was referred here by a rehabilitation agency approved by the state or the Department of Veteran Affairs.
•I am 18-39 years of age and I am a member of a family that received food stamps within the last two years.
•I received Supplemental Security Income (SSI) benefits within the last two months.
•Within the past year, I was convicted of a felony or released from prison for a felony.
•I am a veteran and either:
A member of a family that received food stamps within the last two years
Entitled to compensation for a service-connected disability
Check here if none of the statements above apply to you. (N/A)
Name __________________________________________________________ Date ____________________________
Please keep this form in your store employee file. For warehouse or corporate locations, please send this form to Human Resources.