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  • Services
    • Excavation
    • Roustabout
    • Trucking
    • Waste Services
  • Careers
  • Safety
  • Contact Us

Personal Information


SSN: XXX-XX-XXXX0 / 11

Company Questions

GENERAL INFORMATION


Are you legally eligible for employment in the United States. *
What languages are you proficient with? *
Have you been previously employed by 4X Industrial?
Are any of your relatives working at 4X Industrial?
Have you ever been known by any other name?
How did you hear about us?

Education


Highest level of education completed *

Personal References





Employment History


Is this your current employer? *

Signature


18.217.185.32

By signing my application below, I agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature.

 

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

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By checking this box, I (a) acknowledge that I have read and understand the federal FCRA Summary of Rights and have been given the opportunity to copy/print the Summary of Rights and (b) agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature.

By checking the box, I (a) acknowledge that I have read and understand the above and also have been given the opportunity to copy/print it, and (b) agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature.

By checking the box, I acknowledge that I have read and understand The Fair Credit Reporting Act.


AUTHORIZATION FOR CONSUMER REPORTS


In connection with my application for employment (including contract) with 4x Industrial, I understand consumer reports will be requested by 4x Industrial LLC ("Company"). These reports may include, as allowed by law, the following types of information, as applicable: names and dates of previous employers, reason for termination of employment, work experience, education, accidents, licensure, credit, etc. I further understand that such reports may contain public record information such as, but not limited to: my driving record, CDLIS, workers' compensation claims, judgments, bankruptcy proceedings, criminal records, etc., from federal, state, and other agencies that maintain such records.

 

In addition, investigative consumer reports (gathered from personal interviews, as applicable, with former employers or landlords, past or current neighbors and associates of mine, etc.) to gather information regarding my work or tenant performance, character, general reputation and personal characteristics, and mode of living (lifestyle) may be obtained.

 

I understand that Company can use this disclosure and authorization to continue to obtain such consumer reports throughout my employment.

SSN: XXX-XX-XXXX0 / 11

I hereby authorize procurement of consumer report(s) and investigative consumer report(s) by Company. If hired, this authorization shall remain on file and shall serve as ongoing authorization for Company to procure such reports at any time during my employment. I authorize without reservation, any person, business or agency contacted by any consumer reporting agency retained by Company to furnish the above-mentioned information.

 

This authorization is conditioned upon the following representations of my rights:

 

I understand that I have the right to make a request to any consumer reporting agency ("Agency") that supplied the report to the Company upon proper identification, to obtain copies of any reports furnished to Company by the Agency and to request the nature and substance of all information in its files on me at the time of my request, including the sources of information, and the Agency, on Company's behalf, will provide a complete and accurate disclosure of the nature and scope of the investigation covered by any investigative consumer report(s). The Agency will also disclose the recipients of any such reports on me which the Agency has previously furnished within the two year period for employment requests, and one year for other purposes preceding my request (California three years). I hereby consent to Company obtaining the above information from such Agencies. I understand that I can dispute, at any time, any information that is inaccurate in any type of report with the Agency by contacting the Agency directly. I may view the Agency's privacy policy at their website. I understand that I can also contact the Company at 2419 1st Avenue, Greeley, CO, 970-352-1790 to request information about the nature of any consumer reports or investigative consumer reports supplied by an Agency.

 

Agency Contact Information:
HireRight Attn: Consumers Department 14002 E. 21st Street, Suite 1200 Tulsa, OK 74134 (800) 381-0645
http://www.hireright.com/applicants

 

DISA Global Solutions
10900 Corporate Centre Drive/Suite 250
Houston, TX 77041
1-800-752-6432
Tenstreet
120 W. 3rd Street
Tulsa, OK 74103
(877) 219-9283
consumer@tenstreet.com

 

https://www.tenstreet.com/privacy-policy/
As a California applicant, I understand that I have the right under Section 1786.22 of the California Civil Code to contact the Agency during reasonable hours (9:00 a.m. to 5:00 p.m. (CTZ) Monday through Friday) to obtain all information in Agency's file for my review. I may obtain such information as follows: 1) In person at the Agency's offices, which address is listed above or, if not listed above, obtained by contacting Tenstreet by phone. I can have someone accompany me to the Agency's offices. Agency may require this third party to present reasonable identification. I may be required at the time of such visit to sign an authorization for the Agency to disclose to or discuss Agency's information with this third party; 2) By certified mail, if I have previously provided identification in a written request that my file be sent to me or to a third party identified by me; 3) By telephone, if I have previously provided proper identification in writing to Agency; and 4) Agency has trained personnel to explain any information in my file to me and if the file contains any information that is coded, such will be explained to me.

 

I understand that if the report is provided to an employer in the State of Washington, that I can contact the following office for more information regarding my rights under Washington state law in regard to these reports: State of Washington Attorney General, Consumer Protection Division, 800 5th Ave, Ste. 2000, Seattle, Washington 98104-3188, (206) 464-7744.

SSN: XXX-XX-XXXX0 / 11

CORPORATE OFFICE

800 8th Ave., Ste 300
Greeley, CO 80631

TX Operations

2274 Seaborn Rd.,
Ponder, TX 76259

EXCAVATION & GRADING

2419 1st Ave.
Greeley, CO 80631

WEST VIRGINIA

8598 S. Pleasants Hwy
Saint Marys, WV 26170

https://www.cigna.com/legal/compliance/machine-readable-files

This link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

970 352 1790
INFO@4XINDUSTRIAL.COM

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