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Acknowledgement and Authorization

Criminal History Addendum

Please note that a "Yes" answer to any of the following questions will not necessarily disqualify you from employment. This company will only exclude you from employment if we determine that your criminal history has a bearing on the job for which you are applying and it is a business necessity to exclude consideration of your application. Factors such as your age at the time of the offense, how long ago the offense occurred, the seriousness and nature of the offense, and the relevancy of the offense to the job you will be performing will be considered when making any employment decisions. Arrests will not be considered, only convictions.

I understand that, as a condition of my consideration for employment with Gary’s, or as a condition of my continued employment with Gary’s, Gary’s may obtain a consumer report that includes, but is not limited to, my criminal history, driving records, social security verification, employment and education verifications, any other public records and any other information bearing on my character, general reputation, personal characteristics and trustworthiness.

I hereby authorize and consent to Gary’s procurement of such a report. I understand that, pursuant to the federal Fair Credit Reporting Act, Gary’s will provide me with a copy of any such report if the information contained in the report is, in any way, to be used in making a decision regarding my fitness for employment with Gary’s. I further understand that such report will be made available to me prior to any such decision being made, along with the name and address of the reporting agency that produced the report.

I understand that if Gary’s determines that my criminal record is relevant, I will be given notice that I have been screened out because of a criminal conviction; I will be given an opportunity to demonstrate that the exclusion should not be applied due to my particular circumstances; and Gary’s will consider whether the additional information I provided warrants Gary’s making an exception in my case.

I understand the above information about the company’s criminal history check process. I swear that the information I have provided about my criminal history is true and correct. The information I have provided about my criminal history (if any) is complete and fully explained.

I understand that any misrepresentation, deception, or false statement made during the employment process may result in my not being considered for employment, and if not discovered until after my becoming employed, is grounds for, and may result in, my immediate termination.