I certify the answers given herein are true and complete to the best of my knowledge. I understand that a false statement, false answer, an omission, or misleading statement may result in the decision not to hire me, the withdrawal of an offer of employment, or the termination of my employment regardless of when such false, misleading, or erroneous information is discovered.
I authorize NVA Virtual Solutions and/or its subsidiaries, affiliates, other related entities, successors, and/or assigns (the “Company”) to investigate all statements contained in this application for employment as may be necessary for the employer to arrive at an employment decision. I further promise that I will not bring any legal actions or claims against my current or former employers due to their responses to any job reference requests.
In the event of my employment, I understand that false or misleading information given in my application or interview(s) may result in my discharge. I also understand that by accepting employment within the Company I am required to abide by all policies and procedures of the employer, and that I may be discharged and/or disciplined by the employer for any violation of the Company’s policies and procedures, and/or any violations of any Federal, State, or local law, rule or regulation.
This application for employment shall be considered active for a period of time not to exceed 90 days.
By filing this application, I understand, acknowledge, and agree, unless otherwise defined by applicable law, that any employment status I may be offered by this Company is on an “at will” basis, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. I further understand that this “at will” employment relationship may not be changed by any written document or by any conduct unless such change is specifically acknowledged in writing by an authorized executive of this Company. I further understand that the completion of an application is a preliminary step to employment. It does not obligate the Company to offer employment to me or for me to accept employment.
1. FOR CALIFORNIA APPLICANTS: I RECOGNIZE THAT I MAY WAIVE MY RIGHT TO RECEIVE A COPY OF ANY PUBLIC RECORD OBTAINED BY THE COMPANY WHEN CONDUCTING A BACKGROUND INVESTIGATION OF ME PER THE REQUIREMENTS OF CALIFORNIA’S INVESTIGATIVE CONSUMER REPORTING AGENCIES ACT (CALIFORNIA CIVIL CODE § 1786, ET SEQ.).
FOR MARYLAND APPLICANTS: UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.
FOR MASSACHUSETTS APPLICANTS: IT IS UNLAWFUL IN MASSACHUSETTS TO REQUIRE OR ADMINISTER A LIE DETECTOR TEST AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. AN EMPLOYER WHO VIOLATES THIS LAW SHALL BE SUBJECT TO CRIMINAL PENALTIES AND CIVIL LIABILITY.
FOR MONTANA APPLICANTS: THE EMPLOYMENT RELATIONSHIP IS GOVERNED BY THE WRONGFUL DISCHARGE FROM EMPLOYMENT ACT. MONT. CODE ANN. § 39-2-901.
FOR RHODE ISLAND APPLICANTS: IF YOU PROVIDE FALSE INFORMATION ABOUT YOUR ABILITY TO PERFORM THE ESSENTIAL FUNCTIONS OF THE JOB, WITH OR WITHOUT ACCOMMODATIONS, YOU MAY BE BARRED FROM FILING A CLAIM UNDER THE PROVISIONS OF THE WORKERS’ COMPENSATION ACT OF THE STATE OF RHODE ISLAND.
By selecting the “Yes” you are agreeing to electronically access, receive, review, sign, and authenticate certain documents, forms, and/or letters (“Materials”) covered by the federal Electronic Signatures in Global and National Commerce Act (“E-SIGN”), various state electronic transactions acts (“ETAs”), and/or the separate state laws of Illinois, New York, and Washington, including but not limited to the following Materials:
CONSENT TO RECEIVE, REVIEW, ACCESS, SIGN, & AUTHENTICATE CERTAIN DOCUMENTS, FORMS, LETTERS, & OTHER INFORMATION ELECTRONICALLY
(“E-Signature Disclosures & Consent”)
PLEASE READ THE FOLLOWING CAREFULLY.
By selecting the “Yes”, you are agreeing to electronically access, receive, review, sign, and authenticate certain documents, forms, and/or letters (“Materials”) covered by the federal Electronic Signatures in Global and National Commerce Act (“E-SIGN”), various state electronic transactions acts (“ETAs”), and/or the separate state laws of Illinois, New York, and Washington, including but not limited to the following Materials:
(a) Disclosure & Authorization form(s);
(b) New York Article 23-A;
(c) Pre-Adverse Action letter;
(d) Summary of Rights under the federal Fair Credit Reporting Act;
(e) Summary of Rights under applicable state law;
(f) A copy of your background check/report;
(g) Adverse Action letter;
(h) Any other background check communication or disclosure;
(i) Offer letter;
(j) I-9 form; and/or
(k) Any other employment-related documents (e.g., wage statements, commission plans, etc.).
These E-Signature Disclosures & Consent apply to all Materials, both current and future, related to your application for or possible employment with NVA Virtual Solutions.
By selecting the “Yes”, you are agreeing that your electronic signature is the equivalent of your handwritten (or wet) signature, with all the same legal and binding effect. In certain cases throughout your employment, you may be asked to click buttons labeled “I Agree,” “I Acknowledge,” or using similar words, or otherwise electronically to acknowledge, accept, review, etc. Materials. These E-Signature Disclosures & Consent apply to those instances as well. You also understand that, in its sole discretion, NVA Virtual Solutions may mail, hand-deliver, communicate, or otherwise send you hard-copy Materials. You may obtain a paper copy of any electronic Materials, including ones already or to be accessed, received, reviewed, and/or signed electronically, by sending a written request to NVA Virtual Solutions at 15015 Westheimer Pkwy D3-234, Houston, TX, 77082. You will be charged a reasonable fee to cover the costs of providing a paper copy. You may withdraw your consent to receive, review, access, sign, and authenticate any additional electronic Materials at any time by canceling these E-Signature Disclosures & Consent. You may cancel these E-Signature Disclosures & Consent and withdraw your consent now by not completing this E-Signature Disclosures & Consent form and exiting the system . You may cancel these E-Signature Disclosures & Consent and withdraw your consent in the future by sending a written cancellation request to NVA Virtual Solutions at 15015 Westheimer Pkwy D3-234, Houston, TX, 77082 or email@example.com.
Any withdrawal of your consent will be effective after a reasonable period of time in order for NVA Virtual Solutions to process your withdrawal. Withdrawal of your consent will have no legal effect on the validity, effectiveness, or enforceability of (a) any authorization, consent, or e-signature provided by you prior to the effective date of your withdrawal or (b) any document, form, letter, etc. that was provided or made available to you in electronic format prior to the effective date of your withdrawal. Withdrawal of your consent (i.e., canceling these E-Signature Disclosures & Consent) also will not relieve you from the obligation to complete all required Materials. Withdrawal/canceling will require you to receive, review, access, sign, and authenticate these Materials in hard copy instead of electronically. Receiving, reviewing, accessing, signing, and authenticating certain Materials in either electronic or hard copy is a condition of initial and/or continued employment.
You must update NVA Virtual Solutions regarding the information necessary to contact you electronically (including your personal email address) by calling NVA Virtual Solutions at 1.832.844.5627, emailing firstname.lastname@example.org. If you are employed, NVA Virtual Solutions may electronically send Materials to your NVA Virtual Solutions email address or your personal email address, at its discretion.
To access these electronic Materials, you must have (a) a personal computer or mobile device and an operating system capable of receiving, accessing, displaying, and either printing or storing information, (b) an Internet connection, and (c) Internet Browser Software such as Internet Explorer®, Google Chrome®, Safari®, or Firefox®. Your Internet Browser Software must support 128-bit encryption and Secure Sockets Layer (SSL) protocol . If you are able to see these E-Signature Disclosures & Consent, your hardware and software should allow you to access these electronic Materials.
To retain any of these electronic Materials, you may either print or download them. To print these Materials on your computer, you will need a printer connected to your computer with adequate paper. To download these Materials on your computer, you will need an available storage medium, like a hard drive on your computer or a removable thumb drive. To print these Materials on your mobile device, you will need a printer linked with your device (e.g., via Wi-Fi, Bluetooth®, etc.) and/or an application (app) that allows for printing. To store these Materials on your mobile device you will need (1) sufficient storage space on your mobile device and (2) an app or function that allows for the capture of electronic data (e.g., a screenshot). Please follow the instructions for your particular computer operating system and/or software to print and/or to download these Materials.
Each individual screen may need to be printed and/or downloaded separately. If you have trouble printing and/or downloading, please contact the manufacturer of your personal computer or mobile device, computer operating system, web browser, app, or other relevant software or another information source of your choosing.
By selecting the “Yes” I understand that I am:
1. Confirming that I can access these E-Signature Disclosures & Consent.
2. Confirming that I have an email address and that the computer I intend to use to access documents electronically has the hardware and software requirements described in these E-Signature Disclosures & Consent, to access and to retain these electronic Materials.
3. Agreeing to electronically access, receive, review, sign, and authenticate Materials related in any way to my employment with NVA Virtual Solutions, in place of hard copy/paper documents and handwritten signatures.
4. Confirming that I understand how to cancel these E-Signature Disclosures & Consent, should I ever want to do so.
5. Consenting to update NVA Virtual Solutions regarding the information necessary to contact me electronically (including my personal email address) by calling NVA Virtual Solutions at 1.832.844.5627 or emailing at email@example.com.
6. Agreeing that I have read, understand, and agree to all statements, agreements, and acknowledgements in these E-Signature Disclosures & Consent.
Background Check Disclosure
A consumer report is a type of background check in which information (which may include, but is not limited to, criminal background, driving background, character, general reputation, personal characteristics, and mode of living) about you is gathered and communicated by a consumer reporting agency (“CRA”) to NVA Virtual Solutions and/or its subsidiaries, affiliates, other related entities, successors, and/or assigns (the “Company”). Company may obtain a consumer report on you to be used for employment purposes, including your application for employment.
State Law Disclosures
In addition to the disclosures set forth in the separate Background Check Disclosures screen, below please find state disclosures/notices that may pertain to you. Please note: state disclosures that overlap with the disclosures set forth in the separate Background Check Disclosures form are not repeated in these State Law Disclosures.
Minnesota applicants/employees only: You have the right to request a complete and accurate disclosure of the nature and scope of any consumer report from First Advantage Consumer Center P.O. Box 105292, Atlanta, GA 30348-5292 .
New York applicants/employees only: Upon request, you will be informed whether or not a consumer report was requested, and if such a report was requested, informed of the name and address of the CRA that furnished the report. Your written request should be made to NVA Virtual Solutions, Attention: Background Checks, 15015 Westheimer Pkwy D3-234, Houston, TX, 77083. You may also contact the Company at 1-832-844-5627.
NVA Virtual Solutions and/or its subsidiaries, affiliates, other related entities, successors, and/or assigns may request or utilize subsequent consumer reports (other than investigative consumer reports) on you throughout your employment.
California State Law Disclosures
For California applicants/employees only: Under California law, an “investigative consumer report” is a consumer report in which information on a consumer’s character, general reputation, personal characteristics or mode of living is obtained through any lawful means. In connection with your application for employment and/or continued employment with NVA Virtual Solutions and/or its subsidiaries, affiliates, other related entities, successors and/or assigns (“Company”), Company intends to procure, as defined under California law, an investigative consumer report for employment purposes.
With respect to any investigative consumer report from an investigative consumer reporting agency (“ICRA”), Company may investigate the information contained in your employment application, and other background information about you, including but not limited to obtaining a criminal record report, obtaining information about your character, general reputation, personal characteristics and mode of living, verifying references, work history, your social security number, your educational achievements, licensure, certifications, driving records, and other information about you, including interviewing people who are knowledgeable about you. The results of this report may be used as a factor in making employment decisions. The source of any investigative consumer report (as this term is defined under California law and as explained more fully above) will be First Advantage Consumer Center P.O. Box 105292, Atlanta, GA 30348-5292, https://fadv.com/ and 800-845-6004.
Information regarding FADV’s privacy practices can be found at https://fadv.com/privacy-policy/. The Company will provide you with a copy of an investigative consumer report when required to do so under California law.
Under California Civil Code section 1786.22, you are entitled to a visual inspection of files maintained on you by an ICRA, as follows:
(1) In person, if you appear in person and furnish proper identification, during normal business hours and on reasonable notice. A copy of your file shall also be available to you for a fee not to exceed the actual costs of duplication services provided;
(2) By certified mail, if you make a written request, with proper identification, for copies to be sent to a specified addressee. An ICRA complying with requests for certified mailings under the California Code shall not be liable for disclosures to third parties caused by mishandling of mail after such mailings leave the ICRA;
(3) A summary of all information contained in your files and required to be provided by the California Code shall be provided to you by telephone, if you have made a written request, with proper identification for telephone disclosure, and the toll charges, if any, for the telephone call are prepaid by you or charged directly to you.
“Proper Identification” means information generally deemed sufficient to identify you, which includes documents such as a valid driver’s license, social security account number, military identification card, and credit cards. Only if you cannot identify yourself with such information may the ICRA require additional information concerning your employment and personal or family history in order to verify your identity.
The ICRA will provide trained personnel to explain any information furnished to you and will provide a written explanation of any coded information contained in files maintained on you. This written explanation will be provided whenever a file is provided to you for visual inspection. You may be accompanied by one other person of your choosing, who must furnish reasonable identification. An ICRA may require you to furnish a written statement granting permission to the ICRA to discuss your file in such person’s presence.
Background Check Authorization
To the extent permitted by applicable state law, I hereby consent to this investigation and authorize NVA Virtual Solutions, and/or its subsidiaries, affiliates, other related entities, successors, and/or assigns (the “Company”) to procure consumer report(s), criminal background check(s), and/or investigative consumer report(s) (as defined by applicable California state law), on my background from a consumer reporting agency (“CRA”) or from an investigative consumer reporting agency (“ICRA”), as described in the Background Check Disclosures, the State Law Disclosures, and the California State Law Disclosures (all of which I have received separately from the Company). I have reviewed and understand the information, statements, and notices in the Background Check Disclosures, the State Law Disclosures, and the California State Law Disclosures, as well as this Background Check Authorization.
My authorization remains valid throughout my employment with the Company, such that, to the extent permitted by applicable law, I agree the Company can procure additional consumer report(s) and/or criminal background check(s), during my employment without providing additional disclosures or obtaining additional authorizations. Except as otherwise prohibited by state law, I consent to and authorize the Company to share this information with the Company’s current or prospective clients, customers, others with a need to know, and/or their agents (including but not limited to staffing/placement company clients and vendor credentialing companies) for business reasons (e.g. to place me in certain employment positions, jobs, work sites, etc.).
1. For California, Minnesota, or Oklahoma applicants/employees only: If you would like to receive from (as applicable) the CRA, the ICRA, or the Company, a copy of the background check report that the Company may procure, please check this box.
By checking “Yes”, and clicking “Next” button below, you consent, authorize, agree, and confirm your review and understanding, as set forth in this Authorization.