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Employee Inquiry Release

In connection with my application for employment, I understand that investigative inquiries on my background, in accordance with the Fair Credit Reporting Act and all state and federal laws, are to be made on me, including information as to my personal character, abilities, work habits, mode of living, residency, immigration status, general reputation, performance, experience and other qualities pertinent to my quali cation for employment, including reasons for termination of past employment.

I understand Acme Oyster House® and/or Tracepoint, LLC may make inquiries, including but not limited to my worker’s compensation history, consumer credit history, education, professional licensing, criminal history and driving history. Furthermore, I understand that Acme Oyster House® and/or Tracepoint, LLC may request information from various federal, state and other agencies that maintain records concerning my past driving history, credit history, military history, civil and other experiences, as well as claims involving me in the les of insurance companies.

I understand that information regarding my worker’s compensation history is for the purpose of making certain that I am not hired for a position or assigned a job function that could aggravate the previous injury. I furthermore understand that in compliance with the America With Disability Act, my worker’s compensation history will only be investigated by Acme Oyster House® and/or Tracepoint, LLC after a conditional offer of employment has been extended to me.

I understand that according to the Fair Credit Reporting Act, I am entitled to know if employment is denied because of information obtained by Acme Oyster House® from a Consumer Reporting Agency. Upon written request, I will be informed whether an investigative consumer report was requested and will be given full information as to the nature and scope of this investigation, as well as the name of the reporting agency or sources of information.

I authorize without reservation, any party (including, but not limited to, employers, law enforcement agencies, state agencies, institutions and private information bureaus or repositories) contracted by Acme Oyster House® and/or Tracepoint, LLC to furnish any or all of
the above mentioned information. In addition, I hereby release Acme Oyster House® and Tracepoint, LLC from any and all liability for damage arising from the investigation and disclosure of the requested information. I further release and discharge all liability from all companies, agencies, of cials, of cers, employees and other persons, who, in good faith, provide to Acme Oyster House® and/or Tracepoint, LLC the above mentioned information is requested, in order to successfully complete a background investigation for my application of employment. I will allow a photocopy of the authorization to be as valid as the original.

AGREEMENT: By signing this Electronic Signature Acknowledgment Form, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.

**Date of Birth is being requested only for the purpose of identification in obtaining accurate retrieval of records, and will not be used for discriminatory purposes.

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