Notice Regarding Background Investigation AUTHORIZATION FOR BACKGROUND INVESTIGATION NOTICE REGARDING BACKGROUND INVESTIGATION A consumer report and/or an investigative consumer report including information concerning your character, employment history, general reputation, personal characteristics, police record, education, qualifications, motor vehicle record, mode of living, and/or credit and indebtedness may be obtained in connection with your application for and/or continued employment with Consumers Energy. A consumer report and/or an investigative consumer report may be obtained at any time during the application process, or at any time throughout your employment with Consumers Energy. Any offer of employment with Consumers Energy is contingent upon the results of a background investigation, including a consumer report and/or an investigative consumer report. Upon timely written request of Personnel Department of the company, and within 5 days of the request, the name, address, and phone number of the reporting agency and the nature and scope of the investigative consumer report will be disclosed to you. In addition, before any adverse action is taken, based in whole or in part of the information contained in the consumer report, you will be provided a copy of the report; the name, address and the telephone number of the reporting agency; a summary of your rights under the Fair Credit Reporting Act; as well as additional information on your rights under the law. Consumers Energy may use information in the consumer report and/or investigative consumer report for decisions related to your continued employment or application for employment with Consumers Energy. Nothing in this document creates an employment agreement between you and Consumers Energy. AUTHORIZATION By signing below, I hereby consent to the preparation of a consumer report and/or an investigative consumer report by a consumer reporting agency, and I agree that such reports can be released to Consumers Energy for use in making determinations as to my eligibility for employment, promotion, retention, or for any other lawful employment purposes. I understand that I have rights under the Fair Credit Reporting Act, including rights discussed above. This authorization shall be valid for any reports that may be requested at the time of my application for employment with Consumers Energy, or at any time throughout my employment with Consumers Energy. By signing below I also certify that the information provided in my resume and/or application for employment is accurate. Personal Information Name First Middle Last Suffix Date of Birth (For ID Purposes Only) Social Security Number Driver's License Number DRIVER'S LICENSE STATE: State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Any other names I have been known by: Current Address Address Address 2 City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Previous Address if less than 7 years at current address Address Address 2 City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Include additional addresses here if you need more room: I give consent for Consumers Energy to conduct a background investigation. Yes No Signature Sign above Check for CA, MN, or OK applicants only, if you would like to receive a copy of the consumer report if one is obtained.
