Waiver / Authorization Form Step 1 of 5 - Personal Information 20% I hereby consent and authorize: The Atlantis Security Co. to prepare a consumer report including but not limited to obtaining information as to my credit worthiness, credit standing, character, general reputation, credit capacity, personal characteristics and mode of living. This report may include claims involving me in the files of insurance companies and involve personal interviews with sources such as neighbors, friends, associates, present/past employers and educational institutions. Public records may be used in this report, such as civil and criminal records, driving records, liens, judgments and bankruptcies that are deemed to have abearing on my job performance. I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY THE ATLANTIS SECURITY COMPANY TO FURNISH THE ABOVE-MENTIONED INFORMATION. Upon presentation of proper identification, I have the right to request the nature and substance of all information in your or your agent’s files on me, including the sources of information. If hired (or contracted), the authorization shall remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my employment (or contract period). Prospective Employer: The Atlantis Co.Name* First Middle Last Suffix Maiden Name(Or other names & dates used by applicant) Current Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Social Security No.*Date of Birth* Date Format: MM slash DD slash YYYY Driver's License No.*State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificMay we contact your current employer?YesNoN/ANot at this time Previous Addresses of Last 7 YearsAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe From* Date Format: MM slash DD slash YYYY To* Date Format: MM slash DD slash YYYY Add residenceRemove residence I may request a copy of any report that is prepared regarding me and a “Summary of Your Rights under the Fair Credit Reporting”. I may also request the nature and substance of all information about me contained in the files of the consumer reporting agency. I understand that I have the right to inspect those files with reasonable notice during regular business hours and I may be accompanied by one (1) other person. The consumer reporting agency is required to provide someone to explain the contents of my file. I understand proper identification will be required and I should direct all my requests to: The Atlantis Security Company 101 Ken Mar Industrial Parkway, Ste 105 Broadview Heights, OH 44147 Phone: 1-800-701-8665Are you employed in, seeking employment in, or reside in any of the following states?*Please select all that apply. California Minnesota Oklahoma Maine New York All Other US States Do you wish to receive a copy of any consumer report you are the subject of?*YesNoMaine and New York: You have the right, upon request, to be informed of whether a consumer report about you was requested by the above named company.Are you seeking employment in New York?*YesNoNew York: By law you must be provided with the Disclosure and Release form of Article 23-A of New York Correction Law.All Other US States: Please contact The Atlantis Security Company or the address above to request a copy of your consumer report. Consent*I authorize in writing the above named company to procure a Consumer Report about me from The Atlantis Security Company. I am willing to let a photocopy of this authorization be accepted with the same authority as the original; and that if employed by the above named company this authorization will remain in effect throughout such employment unless prohibited by applicable state laws. I agree.Signature*Date* Date Format: MM slash DD slash YYYY Due to the high volume of Officers that The Atlantis Company hires, we are requesting prior to being hired that you provide us with your uniform sizes. Please note uniforms do not run ‘true sizes’. Uniforms run smaller than what is stated. Providing The Atlantis Company with this information does not mean the company is obligated to offer you employment.Shirt Size*XSSMLXLXXL3XLLong Sleeve Shirt Size*XSSMLXLXXL3XLSweater Size*XSSMLXLXXL3XLJacket Size*XSSMLXLXXL3XLSleeve Length*Please enter a number from 28 to 36.Pants Waist*Please enter a number from 26 to 50.Pants Length*Please enter a number from 24 to 36.