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Personal Information

Have you ever worked for this company before? *
Do you know any current employee(s) of CUSC? *
Are you legally authorized to work in the United States? *
Have you ever pleaded guilty, no contest or been convicted of a crime? *


Days Available *
Shift preference: *
Which location are you applying for? *

Employment History

Employer 1
May we contact? *
Employer 2
May we contact? *
Employer 3
May we contact? *


High School
Did you graduate? *
Did you graduate? *

Additional Skills

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby release employers, schools or individuals from all liability when responding to inquiries in connection with my application. In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge. *

Employment Disclosure ( Amendment to Employee Application)

Have you ever had any Bond coverage revoked, or has any application for a bond been declined? *
Have you ever been convicted of, or pled guilty, or nolo contender ( no contest), in a domestic or foreign court, to any felony or misdemeanor ( excluding minor traffic violations)? *
Are you presently the subject of any criminal action investigation or proceeding or have you ever entered into a Nolle Prosequi ( no prosecution) diversionary program? *
Has any organization over which you exercised management or policy control, ever been convicted of any misdemeanor or felony act during, or as a result of your employment? *
Have you ever had any insurance or insurance license suspended or revoked? *
I certify that the statements above ( an amendment to the Employment Application) and on the employment application are true. I agree to hold harmless the employer, insurer, or their agents against any and all actions, proceedings, liabilities, damages, loss, cost, and expense, including legal fees, that it may sustain or become liable for by reason of any dishonesty on my behalf. *

Please read before signing

If you have any questions regarding this statement or any part of this application, please obtain clarification before signing. As an applicant for employment with the CU Service Centers, Inc., I understand the following:
• This application will remain on file by a specific job title for sixty (60) days. If I am hired within this period this form will be transferred to my individual personnel file. As an employee, consideration for vacated/posted positions will be extended per applicable policy. As an employee, all their External Applications for Employment will be void.
• If I am not hired within sixty (60) days, this application is no longer active and I will need to reapply for employment if I wish to be considered for a position with CU Service Centers, Inc.
• All information submitted to CU Service Centers, Inc. (including but not limited to, resumes, transcripts, letters of reference, interview information, etc.) is subject to verification. I voluntarily give CU Service Centers the right to conduct a thorough investigation of my current and past employment, education, credit history, bondability, and job-related activities. I hereby release from liability CU Service Centers, Inc. and its representatives for seeking such information and all other persons, education institutions, law enforcement agencies, credit reporting agencies, corporations, organizations, or individuals for furnishing such information.
• I authorize CU Service Centers, Inc. to engage an investigative consumer reporting agency to report on my credit and personal history. I may request in writing, from CU Service Centers, Inc. the name and address of the reporting agency so I may obtain from them the nature and substance of the information contained in the report.
• If my application for employment is accepted, the effective date of my employment shall be the date and time I actually begin work.
• If employed, I agree to conform to the rules, regulations, and Ethics Code of CU Service Centers, Inc. I further understand that these rules, regulations and Ethics Codes may be changed, interpreted, withdrawn, or supplemented any time without prior notice.
• I agree that my employment is “at-will” and can be terminated, with or without cause, at any time, at the option of CU Service Centers or myself. I understand that no representative of CU Service Centers, Inc. has the authority to make any assurances to the contrary, now or in the future.
• This information provided in the Application for Employment is true, correct, and complete, understand that any misrepresentation or omissions, either direct or implied, made by me on the application or in subsequent interviews will be cause for cancellation or this application and/or separation if I have been employed.
• The application must be signed. *

Release of Records

Signature: I hereby authorize and request any present or former employer, school, police department, court, financial institution or other persons having knowledge about me, to furnish the bearer (employer, their insurer, or their agents) with any and all information in their possession regarding me in connection with an application for employment. I am willing that a photocopy of this authorization be accepted with the same authority as the original, and I specifically waive any written notice from any present or former employer who may proved information based on this authorized request. I understand this authorization is to be part of the written employment application which I sign. I understand that in the event that I am hired, and it is later discovered by the employer that any of the answers given are untrue or inaccurate, the insurer at its option my cancel my bond and/or the employer may terminate my employment. I have been given the “Consumer Notification” that a report will be requested and used for the purposed of evaluating me for employment, promotion, reassignment or retention as an employee. I have also been given a “Summary of Your Rights Under the Fair Credit Reporting Act”. *




This is used to inform you that a consumer report or an investigative consumer report is being obtained from a consumer reporting agency for the purpose of evaluating you for employment, promotion, reassignment or retention as an employee.

This report may contain information bearing on your creditworthiness, credit standing, credit capability, character, general reputation, personal characteristics, or mode of living from public record sources or through personal interviews with your past or present employers, neighbors, or associates.


The federal Fair Credit Reporting Act (FCRA) is designed to promote accuracy, fairness, and privacy of information in the files of every “consumer reporting agency” (CRA).  Most  CRA’s are credit bureaus that gather and sell information about you – such as if you pay your bills on time or have filed for bankruptcy – to creditors, landlords, and other businesses.  You can find the complete text of the FCRA 15 U.S.C. 1681-1681u, at the Federal Trade Commission’s web site (  The FCRA gives you specific rights, as outlined below.  You may have additional rights under state laws. You may contact state or local consumer protection agency or a state attorney general to learn those rights.

*You must be told if information in your file has been used against you.  Anyone who uses information from a CRA to take action against you – such as denying an application for credit, insurance, or employment- must tell you, and give you the name, address, and phone number of the CRA that provided the consumer report.

*You can find out what is in your file.  At your request, a CRA must give you the information in your file, and a list of everyone who has requested it recently.  There is no charge for the report if a person has taken action against you because of information supplied by the CRA, if you request the report within 60 days of receiving notice of the action.  You are also entitled to one free report every twelve months upon request if you certify that (1) you are unemployed and plan to seek employment within 60 days, (2) you are on welfare, or (3) your report is inaccurate due to fraud.  Otherwise, a CRA may charge you up to eight dollars.

*You can dispute inaccurate information with the CRAIf you tell a CRA that your file contains inaccurate information, the CRA must investigate the items (usually within 30 days) by presenting to its information source all relevant evidence you submit, unless our dispute is frivolous.  The source must review your evidence and report its findings to the CRA.  (The source also must advise national CRAs – to which it has provided the data – of any error).  The CRA must give you a written report of the investigation and a copy of your report if the investigation results in any change.  If the CRA’s investigation does not resolve the dispute, you may add a brief statement to your file.  The RA must normally include a summary of your statement in future reports.  If an item is deleted or a dispute statement is filed, you may ask that anyone who has recently received your report be notified of the change.

*Inaccurate information must be corrected or deleted.  A CRA must remove or correct inaccurate or unverified information from its files, usually within 30 days after you dispute it.  However, the CRA is not required to remove accurate data from you file unless it is outdated (as described below) or cannot be verified.  If your dispute results in any change to your report, the CRA cannot reinsert into your file a disputed item unless the information source verifies it accuracy and completeness.  In addition, once you have notified the source of the error in writing, it may not continue to report the information if it is, in fact an error.

*You can dispute inaccurate items with the source of the information.  If you tell anyone-such as a creditor who reports to the CRA-that you dispute an item, they may not then report the information to a CRA without notice or your dispute.  In addition, once you have notified the source of the error in writing, it may not continue to report the information if it is, in fact an error.

*Outdated information my not be reported.  In most cases, a CRA may not report negative information that is more than seven years old; ten years for bankruptcies.

*Access to your file is limited.  A CRA may provide information about you only to people with a need recognized by the FCRA-usually to consider an application with a creditor, insurer, employer, landlord, or other business.

*Your consent is required for reports that are provided to employers, ore reports that contain medical information.  A CRA may not give out information about you to your employer, or prospective employer, without your written consent.  A CRA may not report medical information about you to your creditors, insurers, or employers without your permission.

*You may choose to exclude your name from CRA lists for unsolicited credit and insurance offers.  Creditors and insurers may use file information as the basis for sending you an unsolicited offer of credit or insurance. Such offers must include a toll-free number for you to call if you want your name and address removed from future lists.  If you call, you must be kept off the lists for two years.  If you request, complete, and return the CRA form provided for this purpose, you must be taken off the lists indefinitely.

*You may seek damages from violators.  If a CRA, a user or (in some cases) a provider or CRA data, violates the FCRA, you may sue them in a state or federal court.