Step 3: Background & References Check

Step 3: Background & References check

We'll need to run a background check before you can become a Consultant.

BACKGROUND CHECK

* Indicates required field

Name *

First

Last

Social Security Number *

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Driver's License *

License State *

Driver's License Expiration Date

Month *

Day *

Year *

Date of Birth

Month *

Day *

Year *

You must be 21 or older to drive and work with Student Learners at Le Blanc Consulting.

Electronic Signature *

First

Last

By typing your name, you indicate you've read and agree to authorize a background check following the terms below. BACKGROUND CHECK TERMS Le Blanc Consulting, Inc. the entity that contracts with Consultants who provide educational training, and who provide peer-to-peer transportation requested through the Le Blanc Consulting app, is committed to safety. As part of that commitment, Le Blanc uses a third-party vendor to conduct a criminal background check, motor vehicle record check, and other checks. Please review the below disclosure/authorization and release. DISCLOSURE/AUTHORIZATION AND RELEASE FOR THE PROCUREMENT OF A CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT DISCLOSURE: Le Blanc Consulting, Inc. may now, or at any time while you are an independent consultant and independent transportation provider (“Transportation Provider”) (“Education Consultant”), with an independent contractor relationship (“I/C Relationship”) with Consulting, Inc., verify information within your proposal to enter into or maintain an I/C Relationship, resume or contract by obtaining a consumer report and/or investigative consumer report from a consumer reporting agency. The verification and/or checks may include but are not limited to: driving records, workers compensation records (in compliance with the ADA or other applicable law), credit bureau files, employment references, personal references, any educational and licensing institution records, and any criminal records information pertaining to you which may be in the files of any federal, state or local criminal justice agency in any state. These reports may include information as to your general reputation, character, personal characteristics, or mode of living. You have the right to request, in writing, the nature and scope of any investigative consumer report conducted by Le Blanc Consulting, Inc. on behalf of Le Blanc Consulting, Inc., at: 2415 San Pablo Dam Rd #106-152. San Pablo, CA. 94806• 1510-326-3313• www.LeBlancConsulting.net. A photocopy or telephonic facsimile (fax) or electronic copy of this Disclosure/Authorization and Release shall be valid as the original, and my electronic signature will be binding. I further understand that I may request and obtain a paper copy of this Notice/Authorization and Release by contacting Le Blanc Consulting, Inc. at the above address. The results of this verification process will be used as a factor in determining your eligibility to enter into or maintain an I/C Relationship with Le Blanc Consulting, Inc. All results will be kept CONFIDENTIAL. The information obtained will not be provided to any parties other than to authorized personnel of Le Blanc Consulting, Inc or its corporate affiliates, unless otherwise required by law. According to the Fair Credit Reporting Act, if any adverse decision is made with regard to your eligibility as a Transportation Provider, based entirely or in part on the information contained in a consumer report or investigative consumer report prepared by a consumer reporting agency, you are entitled to receive a copy of this report upon written request, and a disclosure of the nature and scope of the investigative report. AUTHORIZATION: I have carefully read and understand this disclosure and consent form and by my signature consent to the release of consumer or investigative consumer reports, as defined above, in conjunction with my proposal to enter an I/C Relationship. I further understand this consent will apply during the course of my I/C Relationship, should I enter an I/C Relationship with LeBlanc Consulting, Inc, and that such consent will remain in effect until revoked in a written document signed by me. As allowed by law, Le Blanc Consulting, Inc may obtain background investigations from a consumer reporting agency other than Le Blanc Consulting, Inc. In the event that I wish to refuse or revoke my consent at any time, I understand that I may do so. I further understand that any and all information contained in my proposal to enter an I/C Relationship, or otherwise disclosed to this company by me, may be used for the purpose of obtaining the consumer reports or investigative consumer reports requested by Le Blanc Consulting, Inc and confirm that all such information is true and correct. I, the undersigned, do hereby certify that the information provided by me in connection with proposal to enter an I/C Relationship is true and complete to the best of my knowledge. I understand that if I enter an I/C Relationship with Le Blanc Consulting, Inc, any false statements will be considered as a cause for possible termination of the I/C Relationship. By entering my name in the box below and clicking “Submit,” I acknowledge and agree that I am providing my electronic signature, that my electronic signature is binding just like a signature in ink, and that my electronic signature demonstrates my authorization for a consumer report and/or investigative consumer report as described above.

Date *

By typing your name, you indicate you've read and agree to authorize a background check following the terms above. *

I request a copy of my background report

Submit