Candidate Application
First Name (must match driver's license): Ange
Last Name (must match driver's license): Seka
Address 1: 9455 Skillman Street #1005Last Modified: 09/01/2020 01:09 PM
Address 2: Created: 08/27/2020 04:36 PM
City: Dallas ROUTE DELIVERY DRIVERS -
Job:
State: TX DDA2 [1046]
Zip: 75243 Source:
Phone: (973) 536 4291 Rating:
Email:
[email protected] Disposition:
Date of Birth: 12/20/1986 Referred By:
Social Security Number: 890420793 Start Date:
Driver License Number: 43875444 Score: N/A
Driver's License Expiration: 12/20/2024 Current Stage: Part 1 Complete
Driver's License State: TX
Are you a Re-hire?: No
Dates Employed Employer Name & Address Employer Phone
From:
To:
Position Supervisor Name & Title May we Contact?
Duties Reason for Leaving Salary/Wages
Start:
Final:
EMPLOYER 4
Dates Employed Employer Name & Address Employer Phone
From:
To:
Position Supervisor Name & Title May we Contact?
Duties Reason for Leaving Salary/Wages
Start:
Final:
EMPLOYER 5
Dates Employed Employer Name & Address Employer Phone
From:
To:
Position Supervisor Name & Title May we Contact?
Duties Reason for Leaving Salary/Wages
Start:
Final:
EMPLOYER 6
Dates Employed Employer Name & Address Employer Phone
From:
To:
Position Supervisor Name & Title May we Contact?
Duties Reason for Leaving Salary/Wages
Start:
Final:
EMPLOYER 7
Dates Employed Employer Name & Address Employer Phone
From:
To:
Position Supervisor Name & Title May we Contact?
Duties Reason for Leaving Salary/Wages
Start:
Final:
EMPLOYER 8
Dates Employed Employer Name & Address Employer Phone
From:
To:
Position Supervisor Name & Title May we Contact?
Duties Reason for Leaving Salary/Wages
Start:
Final:
EMPLOYER 9
Dates Employed Employer Name & Address Employer Phone
From:
To:
Position Supervisor Name & Title May we Contact?
Duties Reason for Leaving Salary/Wages
Start:
Final:
MILITARY SERVICE
BRANCH OF SERVICE DATES RANK & DUTIES DATE DISCHARGED
From:
To:
PERSONAL REFERENCES
YEARS
NAME ADDRESS TELEPHONE
KNOWN
Ayeli Kougnon 9455 Skillman St #1005 1 832 406 1237
ADDITIONAL INFORMATION
* Have you filed an application here before?: No
If Yes, give date:
* Are you 18 years of age or older?: Yes
* Are you employed now?: Yes
* May we contact your present employer?: No
* Are you prevented from lawfully becoming employed in
this country because of Visa or Immigration Status? (Proof
No
of citizenship or immigration status will be required upon
employment ):
* On what date would you be available for work: 09/01/2020
Are you available to work: Full Time
* Are you on a lay-off and subject to recall?: No
* Can you travel if a job requires it?: Yes
* Can you relocate?: No
* Have you been convicted of a felony within the last 7
years? (Conviction will not necessarily disqualify applicant No
from employment.):
If Yes, please explain:
DRIVING INFORMATION
* Date of Birth: 12/20/1986
* Driver's License #: 43875444
* State: TX
* Has your drivers license ever been suspended?: No
If Yes, give reason:
APPLICANT'S STATEMENT
I certify that answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of
facts called for is cause for dismissal. Further, I understand and agree that my employment is for no definite period and
may, regardless of the date of payment of my wages and salary, be terminated at any time without any previous notice. I
authorize the prospective employer ot it's agents to obtain a copy of my driving record for employmnet and isurability
purposes.
* Signature (type name): Ange Seka
* Date: 08/27/2020
MUST BE READ AND SIGNED BY THE APPLICANT
It is agreed and understood that the employer or its agents may investigate the applicant's background to ascertain
any and all information of concern to applicant's record whether same is of record or not, and applicant releases
employers and persons named herein from all liability for any damages on account of furnishing such information.
In accordance with the provision so Section 604(b)(2)(a) of the Fair Credit Reporting Act Public Law 9f-508, as
amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter 1, of Public Law 104-208), you
are being informed that reports verifying your previous employment, previous drug and alcohol test results, and your
driving record may be obtained on you for employment purposes.
The applicant agrees to furnish such additional information and complete such examinations as necessary to
complete applicant's employment file.
It is agreed and understood that this application for employment in no way obligates the employer to employ the
applicant.
It is agreed and understood that if hired, the applicant may be on a probationary period during which time applicant
may be discharged without recourse. Further, any false statement herein submitted will be deemed sufficient reason
for rejection or termination of the applicant's employment, irrespective of time lapsed before discovery.
In connection with my application for employment with you, I understand that an investigative consumer report is
being requested from Hire Right Services that will include information as to my character, work habits, performance,
and experience, along with reasons for termination of past employment obtained from previous employers. Further, I
understand that you will be requesting information concerning my driving record and/or information from various state
agencies which maintain records concerning traffic offenses, accidents, etc., as well as information from Hire Right
Services concerning (1) previous driving record requests made by others from such stage agencies and (2) claims
involving me in the files of insurance companies. I have a right to make a written request within a reasonable period
of time to receive additional detailed information about the nature and scope of this investigation. I hereby consent to
your obtaining the above described information from Hire Right Services, and agree that such information which Hire
Right Services has or obtains, and my employment history with you, if I am hired, will be supplied by to other
companies which subscribe to Hire Right Services. Information about Hire Right's privacy practices is available at
http://www.hireright.com/legal/privacy-policy
IF HIRED BY YOU, I FURTHER CONSENT TO YOUR FURNISHING TO HIRE RIGHT SERVICES INFORMATION
CONCERNING MY CHARACTER, WORK HABITS, PERFORMANCE DRIVING RECORD AND EXPERIENCE, AS
WELL AS ANY REASONS FOR TERMINATION OF MY EMPLOYMENT, AND FURTHER CONSENT TO HIRE
RIGHT SERVICES FURNISHING SUCH INFORMATION IN THE FUTURE TO OTHER COMPANIES WHICH
SUBSCRIBE TO HIRE RIGHT SERVICES FROM WHICH I MAY BE SEEKING EMPLOYMENT, AND TO
INSURANCE COMPANIES OR THEIR AGENTS IN CONNECTION WITH ISSUANCE OR MAINTENANCE OF
INSURANCE COVERAGE.
The applicant agrees to conform to the rules and regulations of the Company, and understands that employment and
compensation can be terminated with or without cause, at any time, at the option or either the Company or the
individual.
The applicant further understands that no personnel recruiter or interviewer or other representative of the Company
other than the President, has any authority to enter into any agreement for employment for any specified period of
time.
If requested to do so, I agree to submit to physical and psychological testing prior to employment, or at any time
during my employment, including but not limited to a polygraph and/or urine analysis to test for drugs or alcohol. It is
agreed and understood that the answers to the foregoing questions are true and correct, and that any
misrepresentations of information given above shall be considered an act of dishonesty. Further, this certifies that this
application was completed by me, and that all entries on it and information in it are true and complete to the best of
my knowledge.
* Signature (type full name): Ange Seka
* Date: 08/27/2020
Age Confirmation
* Please confirm that you are 21 years old or older.
Yes
Summary of your Rights under the Fair Credit Reporting
A Summary of Your Rights Under the Fair Credit Reporting Act
The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer
reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such
as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of
your major rights under FCRA. For more information, including information about additional rights, go to
www.consumerfinance.gov/learnmore or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC
20552.
• You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of
consumer report to deny your application for credit, insurance, or employment - or to take another adverse action against you -
must tell you, and must give you the name, address, and phone number of the agency that provided the information.
• You have the right to know what is in your file. You may request and obtain all the information about you in the files of a
consumer reporting agency (your "file disclosure"). You will be required to provide proper identification, which may include
your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:
o a person has taken adverse action against you because of information in your credit report;
o you are the victim of identity theft and place a fraud alert in your file;
o your file contains inaccurate information as a result of fraud;
o you are on public assistance;
o you are unemployed but expect to apply for employment within 60 days.
In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau
and from nationwide specialty consumer reporting agencies. See www.consumerfinance.gov/learnmore for additional
information.
• You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on
information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or
distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will
receive credit score information for free from the mortgage lender.
• You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or
inaccurate, and report it to the consumer
reporting agency, the agency must investigate unless your dispute is frivolous. See www.consumerfinance.gov/learnmore for an
explanation of dispute procedures.
• Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete,
or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may
continue to report information it has verified as accurate.
• Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may
not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old.
• Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need -
usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a
valid need for access.
• You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information
about you to your employer, or a potential employer, without your written consent given to the employer. Written consent
generally is not required in the trucking industry. For more information, go to www.consumerfinance.gov/learnmore.
• You may limit "prescreened" offers of credit and insurance you get based on information in your credit report. Unsolicited
"prescreened" offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your
name and address form the lists these offers are based on. You may opt out with the nationwide credit bureaus at 1-888-5-
OPTOUT (1-888-567-8688).
• The following FCRA right applies with respect to nationwide consumer reporting agencies:
CONSUMERS HAVE THE RIGHT TO OBTAIN A SECURITY FREEZE
You have a right to place a "security freeze" on your credit report, which will prohibit a consumer reporting agency from releasing
information in your credit report without your express authorization. The security freeze is designed to prevent credit, loans, and
services from being approved in your name without your consent. However, you should be aware that using a security freeze to
take control over who gets access to the personal and financial information in your credit report may delay, interfere with, or
prohibit the timely approval of any subsequent request or application you make regarding a new loan, credit, mortgage, or any
other account involving the extension of credit.
As an alternative to a security freeze, you have the right to place an initial or extended fraud alert on your credit file at no cost. An
initial fraud alert is a 1-year alert that is
placed on a consumer's credit file. Upon seeing a fraud alert display on a consumer's credit file, a business is required to take
steps to verify the consumer's identity before extending new credit. If you are a victim of identity theft, you are entitled to an
extended fraud alert, which is a fraud alert lasting 7 years.
A security freeze does not apply to a person or entity, or its affiliates, or collection agencies acting on behalf of the person or
entity, with which you have an existing account that requests information in your credit report for the purposes of reviewing or
collecting the account. Reviewing the account includes activities related to account maintenance, monitoring, credit line
increases, and account upgrades and enhancements.
• You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a
furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.
• Identity theft victims and active duty military personnel have additional rights. For more information, visit
www.consumerfinance.gov/learnmore.
States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more
rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney
General. For information about your federal rights, contact:
TYPE OF BUSINESS: CONTACT:
1.a. Banks, savings associations, and credit unions with total assets of over $10 billion and their affiliates
b. Such affiliates that are not banks, savings associations, or credit unions also should list, in addition to the CFPB: a. Consumer
Financial Protection Bureau
1700 G Street, N.W. Washington, DC 20552
b. Federal Trade Commission
Consumer Response Center
600 Pennsylvania Avenue, N.W. Washington, DC 20580
(877) 382-4357
2. To the extent not included in item 1 above:
a. National banks, federal savings associations, and federal branches and federal agencies of foreign banks
b. State member banks, branches and agencies of foreign banks (other than federal branches, federal agencies, and Insured
State Branches of Foreign Banks), commercial lending companies owned or controlled by foreign banks, and organizations
operating under section 25 or 25A of the Federal Reserve Act.
c. Nonmember Insured Banks, Insured State Branches of
Foreign Banks, and insured state savings associations d. Federal Credit Unions a. Office of the Comptroller of the Currency
Customer Assistance Group
1301 McKinney Street, Suite 3450
Houston, TX 77010-9050
b. Federal Reserve Consumer Help Center
P.O. Box 1200
Minneapolis, MN 55480
c. FDIC Consumer Response Center
1100 Walnut Street, Box #11
Kansas City, MO 64106
d. National Credit Union Administration
Office of Consumer Financial Protection (OCFP) Division of Consumer Compliance Policy and Outreach
1775 Duke Street
Alexandria, VA 22314
3. Air carriers Asst. General Counsel for Aviation Enforcement & Proceedings
Aviation Consumer Protection Division
Department of Transportation
1200 New Jersey Avenue, S.E. Washington, DC 20590
4. Creditors Subject to the Surface Transportation Board Office of Proceedings, Surface Transportation Board
Department of Transportation
395 E Street, S.W. Washington, DC 20423
5. Creditors Subject to the Packers and Stockyards Act, 1921 Nearest Packers and Stockyards Administration area supervisor
6. Small Business Investment Companies Associate Deputy Administrator for Capital Access
United States Small Business Administration
409 Third Street, S.W., Suite 8200
Washington, DC 20416
7. Brokers and Dealers Securities and Exchange Commission
100 F Street, N.E. Washington, DC 20549
8. Federal Land Banks, Federal Land Bank Associations, Federal Intermediate Credit Banks, and Production Credit Associations
Farm Credit Administration
1501 Farm Credit Drive
McLean, VA 22102-5090
9. Retailers, Finance Companies, and All Other Creditors Not
Listed Above Federal Trade Commission
Consumer Response Center
600 Pennsylvania Avenue, N.W. Washington, DC 20580
(877) 382-4357
* I acknowledge reading the "Summary of Your Rights under
Yes
the Fair Credit Reporting Act"?:
Confirm Choice, LLC
4205 Hillsboro Rd, Ste 200, Nashville, TN
615-383-5932 (phone) 615-279-5243 (fax)
Background Screening Report
SEKA, ANGE FABRICE
Fusion Logistics, Inc.
4801 S. University Drive Suite 2500 SSN#: XXX-XX-9999 Requested: 09/01/20
Davie, FL 33328 DOB: 12/20/86 Completed: 09/01/20
Requestor: Cykeitha Ogletree
DRIVING HISTORY
Driver's License #: 4387XXXX State Issued: TX
--------------------------------------------------------
Reported Driver's License #: 4387XXXX
--------------------------------------------------------------------------------
TX DRIVER RECORD REPORT
REPORT SEARCH DATE -> 09/01/2020
LICENSE NAME/ADDRESS DRIVER DESCRIPTION
------------------------------ ----------------------------------------
SEKA, ANGE FABRICE DOB/SS# |GENDER/RACE|HT/WT|EYES/H
9750 ROYAL LN APT 303 ===========|========|=====|=======|====
DALLAS, TX 75231 12/20/86 | | | |
| | | |
LICENSE NUMBER ORIG.ISSUED ISSUED EXPIRES CLASS STATUS
----------------- ----------- ---------- ---------- -------- -----------
4387XXXX 09/05/2018 12/20/2024 C - SING VALID (VALI
--------------------------------------------------------------------------------
LIC TYP: PERSONAL
CLASS: C - SINGLE VEH < 26K
STATUS: VALID (VALID)
RESTRICTIONS: N/A
ENDORSEMENTS: N/A
*** MISCELLANEOUS AND STATE SPECIFIC INFORMATION ***
--------------------------------------------------------------------------------
** THIS TYPE OF RECORD WILL NOT REFLECT COMPLETION OF A DRIVING
** SAFETY COURSE.
** THIS RECORD REFLECTS CONVICTIONS AND CRASH INVOLVEMENTS THAT
** ARE ALLOWED TO BE DISPLAYED BY LAW.
NO REPORTABLE INCIDENTS FOUND
*** END OF RECORD ***
End of Report
Test Results
Date Results Transmitted: 2020-09-02 10:02 AM Reason for Test: PRE-EMPLOYMENT
Transmitted By: DRN Date Specimen Collected: 2020-09-01
Participant/Donor: ANGE SEKA
Laboratory: LabCorp
SSN/EID: *****0793 Collection Site: LABCORP - GARLAND, TX (N
CCF/Specimen ID: 0592947283 Collection Site Phone: 9724944655
Specimen Type: URINE Program: NONDOT
Company: FUSION LOGISTICS
Location: FUSION LOGISTICS Date MRO Received CCF Copy 2: 2020-09-02
Lab Account Number: 120634 Date Test Verified by MRO: 2020-09-02
Test Results
Panel - 9 PANEL URINE - 792474 - 120634 6628780001
Drug Results Screen Confirm
Amphetamines NEGATIVE 1000 500
Barbiturates NEGATIVE 300 200
Benzodiazepines NEGATIVE 300 300
Cocaine NEGATIVE 300 150
Marijuana NEGATIVE 50 15
Methadone NEGATIVE 300 300
Opiates NEGATIVE 2000 2000
Phencyclidine (PCP) NEGATIVE 25 25
Propoxyphene NEGATIVE 300 200
MY DETERMINATION/VERIFICATION IS: NEGATIVE
Certified Medical Review Officer
David Nahin M.D.
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