Background Check Disclosure & Authorization (FCRA)

Creating Lasting Memories Through Beautiful Photography.

Stand-alone FCRA disclosure and written authorization for pre-employment and periodic background checks (criminal, MVR, credit where permitted, education, employment). Includes state addenda for NJ, NY, PA, and CT and Summary of Rights.

BTL-PBL-05.016

Form

Vol 05 — Human Resources & Talent

FCRA Stand-Alone Disclosure (15 U.S.C. § 1681b(b)(2))

Notice: Beauty Through the Lens L.L.C. ("the Company") may obtain a consumer report and/or an investigative consumer report about you from a consumer reporting agency for employment purposes, including hiring, retention, promotion, reassignment, or termination. Reports may include criminal records (where permitted by state law), motor-vehicle records where driving is job-related, verification of prior employment, education, professional licenses, and — only where state law permits and the report is used solely for such purposes — credit history. *— This disclosure is provided in a stand-alone document per FCRA § 1681b(b)(2).

Yes / N/A

For investigative consumer reports you have the right, upon written request within a reasonable time, to a complete and accurate disclosure of the nature and scope of the investigation. *

Yes / N/A

I acknowledge receipt of the FTC/CFPB "A Summary of Your Rights Under the Fair Credit Reporting Act." *

Yes / N/A

State Addenda

California / Minnesota / Oklahoma — request a copy of any report prepared

Yes / N/A

New Jersey — I acknowledge my rights under the NJ Opportunity to Compete Act (N.J.S.A. 34:6B-11)

Yes / N/A

New York — I acknowledge Article 23-A of the NY Correction Law and, if in NYC, the Fair Chance Act

Yes / N/A

Pennsylvania — criminal history considered only to the extent it relates to suitability (18 Pa. C.S. § 9125)

Yes / N/A

Connecticut — pre-offer criminal-history inquiry prohibited (Conn. Gen. Stat. § 31-51i)

Yes / N/A

Written Authorization

I authorize the Company and its designated consumer reporting agency to obtain the consumer report(s) described above and to make inquiries of my current and prior employers, schools, licensing bodies, and personal references. A photocopy or electronic copy of this authorization is as valid as the original. *

Yes / N/A

Applicant full legal name *

Other names used / maiden name (last 7 years)

Date of birth (used for identification only) *

Last 4 of SSN (used for identification only)

Driver's license # / state (only if MVR is part of the check)

Applicant signature *

Date *

Company Use — Adverse Action Log (if applicable)

Pre-adverse notice sent (date) — copy of report & Summary of Rights enclosed

Reasonable waiting period (min. 5 business days recommended) ends

Individualized assessment complete (EEOC 915.002 factors)

Yes / N/A

Adverse action notice sent (date)

Decision maker signature

Prepared by

Name · Title · Date

Reviewed by

Name · Title · Date

Approved by

Owner · Katheryn L. Wilkins · Date

Controlled document — BTL-PBL-05.016. Complete all required fields (marked *). Retain per Volume 15 retention schedule.