DELIVERY VENDOR DATA SHEET

VEHICLES

Primary Vehicle

Backup Vehicle

WORK HISTORY

Authorization to Obtain an Investigative or Consumer Credit Report and Release of Information for Contracting Purposes

Pursuant to the federal Fair Credit Reporting Act, I hereby authorize Veritable Screening, 3415 South Sepulveda Blvd., Suite 1100, Los Angeles, California and its designated agents and representatives on behalf of my client (or client to which I am bidding for a contract) to conduct a comprehensive review of my background through a consumer report and/or an investigative consumer report to be generated for contracting purposes or retention as a contractor. I understand the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: verification of Social Security number; current and previous residences; employment history, including all personnel files; education; references; criminal history, including records from any criminal justice agency in any or all federal, state or county jurisdictions; birth records; motor vehicle records, including traffic citations and registration; and any other public records.

By my signature affixed below, I authorize the complete release of these records or data pertaining to me which an individual, company, firm, corporation or public agency may have. I understand that I must provide my date of birth to adequately complete said screening and acknowledge that my date of birth will not affect any contracting decisions. I hereby authorize and request any present or former employer, school, police department, financial institution or other persons having personal knowledge of me to furnish Veritable Screening, Inc. or its designated agents with any and all information in their possession regarding me in connection with a bid to contract. I am authorizing that a photocopy of this authorization be accepted with the same authority as the original.

I hereby release Veritable Screening, Inc. and its agents, officials, representatives or assigned agencies, including officers, employees or related personnel, both individually and collectively, from any and all liability for damages of whatever kind, which may at any time result to me, my heirs, family or associates because of compliance with this authorization and request to release. You may contact me as indicated below. I understand that a copy of this authorization may be given at any time, provided I do so in writing.

I understand that, pursuant to the federal Fair Credit Reporting Act, if any adverse action is to be taken based upon the consumer report, a copy of the report and a summary of the consumer's right will be provided to me.

This Authorization is valid for current and future reports, and specifically understand the Company intends for this Authorization to cover both the bid to contract and, if I am contracted, any additional consumer reports and/or investigative consumer reports obtained while I am a contractor.

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 the FCRA. For more information, including information about additional rights, go to www.ftc.gov/credit or write to: Consumer Response Center, Room 130-A, Federal Trade Commission, 600 Pennsylvania Ave. N.W., Washington, D.C. 20580.

●  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: C 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, by September 2005 all consumers will be entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.ftc.gov/credit 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.ftc.gov/credit 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.ftc.gov/credit.

●   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 (888) 5-OPTOUT (888-567-8688).

●  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.ftc.gov/credit.

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 info, contact your state or local consumer protection agency or your state Attorney General. Federal enforcers are:

VENDOR DRUG-TESTING CONSENT

AND RELEASE FORM

I hereby consent to submit to urinalysis and/or other tests as shall be determined thereof by the CCI as listed

in the Vendor Service Agreement for the purpose of determining specific drug content.

I agree that a D.H.H. S. (and state, where required) certified lab may collect these specimens for these

tests and may use them or forward them to a testing laboratory designated by the CCI for analysis.

I further agree to have these results reviewed by a Medical Review Officer. Ihereby release to CCI, the

results of the test(s) to which I have consented. I further authorize CCI to discuss the results with the

medical/personnel collecting the specimen, the testing facility, it’s directors, officers, agents and employees

responsible for administering the aforementioned test(s) or evaluating the results thereof and any of them

herein and to use the test results in conjunction with contractual actions, professional licensing procedures,

and as a defense in any legal action to which I am party.

I further release any testing facility or any physicians who have tested me from any liability arising from

a release of any and all results, written reports, medical records and data concerning my test(s) to the

appropriate CCI officials or government agencies.

I further agree that a reproduced copy of this consent and release form shall have the same force and

effect as the original.

I have carefully read the forgoing and fully understand its contents. I acknowledge that my signing of

this consent and release is a voluntary act on my part and that I have not been coerced into signing this

document by anyone.

Changing the Default on Iphone
 
iPhones now save pictures as .heic which is not compatible with this upload, you'll need to change default back to .jpg if you're using an iPhone, it's simple to do.

1.   Go to iOS Settings and swipe down to Camera. It’s buried in the 6th block, the one that has Music at the top.

2.   Tap "Formats"

3.   Tap "Most Compatible" to set the default photo format to JPG. 

Now take pictures and you should not have any trouble uploading them.

Uploading Picture

1. Tap on upload field.

2. Choose camera on your phone.

3. Take picture.