| Are you currently working (or will you be working) with a NIS Independent Contractor (Installer)? |
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| At times, an Independent Contractor of National Install Solutions, LLC (NIS) will utilize the services of other individuals or entities (Independent Contractor Personnel) to perform services on their behalf for NIS. These indepdent contractor personnel are under no written or verbal agreement with NIS. Any written or verbal agreement that may be in effect for work performed on behalf of the independent contractor by a crew member or helps does not involve NIS. Accordingly, NIS has no legal obligation to make direct payment to a crew member or a helper or an office individual. NIS is only required to pay the independent contractor per the standard National Install Solutions, LLC Independent Contractor Services Agreement. Crew members, helpers and office individuals receive payment for their services directly from the Independent Contractor. Any dispute in regards to payment for services performed is between the Independent Contractor and the Independent Contractor Personnel. A crew member, helper or office individual understands that NIS (or any client or customer of NIS or of client) has nothing to do with payment disputes or any other disputes that might arise while working for an independent contractor. |
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| Have you completed Federal or State RPP Certified Renovator training? |
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| CONSENT FOR BACKGROUND INVESTIGATION - In order to work as a Crew Member/ Helper or Office Individual, I understand that in order for me to have the opportunity to contract for NATIONAL INSTALL SOLUTIONS, LLC, or for a NATIONAL INSTALL SOLUTIONS, LLC Independent Contractor, NATIONAL INSTALL SOLUTIONS, LLC (NIS) will obtain a consumer report (known as an investigative consumer report in California), which I understand may include information regarding my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. NIS may share the contents of the consumer report with clients in connection with client projects assigned to the Independent Contractor by NIS. |
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| During this process and at any time during the tenure of my relationship with NIS or with an NIS Independent Contractor, I hereby authorize First Advantage, on behalf of NIS, to procure a consumer report (known as an investigative consumer report in California) which I understand may include information regarding my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living. This report may be compiled with information from credit bureaus, courts record repositories, departments of motor vehicles, past or present employers and educational institutions, governmental occupational licensing or registration entities, business or personal references, and any other source required to verify information that I have voluntarily supplied. I understand that I may request a complete and accurate disclosure of the nature and scope of the background verification; to the extent such investigation includes information bearing on my character, general reputation, personal characteristics or mode of living. I further authorize NIS to share the results of any report with a client. |
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| I hereby release First Advantage, NIS, any client of NIS and any person or entity that provides information pursuant to this authorization from any and all liabilities arising from any claims, lawsuits or other actions in regard to the information obtained from any and all of the above referenced sources. I further agree that the giving of any false, misleading, or incomplete information will be grounds for termination of my relationship with NIS. |
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| IN ORDER TO PROCESS THE BACKGROUND INFORMATION, NIS WILL NEED TO OBTAIN YOUR STATE IDENTIFICATION (DRIVER LICENSE) AND SOCIAL SECURITY NUMBER, AS WELL AS YOUR DATE OF BIRTH AND SEVEN YEARS OF ADDRESS HISTORY. THIS INFORMATION IS REQUESTED FOR IDENTIFICATION PURPOSES ONLY. |
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| IN ADDITION, A COPY OF YOUR STATE ISSUED IDENTIFICATION (DRIVER LICENSE OR STATE IDENTIFICATION CARD), SOCIAL SECURITY CARD (NUMBER) AND A PHOTO FOR AN IDENTIFICATION BADGE WILL NEED TO BE UPLOADED BEFORE THE COMPLETION OF THIS PROCESS. |
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| What is your Driver License Number? |
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| What is your Social Security Number? |
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| What is your Date of Birth? |
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| If you have lived at the address you provided above for less than 7 years, please provide your previous address. |
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| Have you been convicted of or plead guilty to or nolo contendere to or no contest to, a felony or misdemeanor, including DUI's or DWI's? This would not include minor traffic violations or a case that has been expunged, sealed, dismissed, erased, pardoned or impounded. NOTE: Answering 'yes' will not necessarily disqualify a person's eligibility to participate in the Program. Factors such as age and date of offense, the seriousness of the violation and rehabilitation will be considered. |
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| BY COMPLETING AND SUBMITTING THIS INFORMATION, YOU GIVE YOUR CONSENT FOR NATIONAL INSTALL SOLUTIONS, LLC TO PROCESS A BACKGROUND INVESTIGATION ON YOU USING THE INFORMATION PROVIDED. |
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