APPLICATION FOR EMPLOYMENT

Transcripción

1 151 N. Lyn Ave, Hemet, CA (951) APPLICATION FOR EMPLOYMENT Psitin Desired: Date: Available Shift: [ ] Part Time [ ] Full Time [ ] Day [ ] Evenings [ ] Weekends [ ] Other: Available Date: Salary Range: Hw did yu hear abut us? [ ] Walk-in [ ] Jbing.cm [ ] Cal-Jbs [ ] EDD [ ] Newspaper: [ ] IDS Emplyee: _ [ ] Other: (Print) Last First Middle Present Address CityStZip Hw lng have yu lived there? Previus Address CityStZip Current r Primary Cntact Telephne N.: ( ) Alternate Daytime Telephne N.: ( ) Hw lng did yu live there? Scial Security N. - - Best time t reach yu: Have yu ever applied with r wrked fr Ebix, Inc, r Insurance Data Services? [ ] Yes [ ] N If yes, please give the date(s) and details: NOTE: Answering yes t these questins des nt cnstitute an autmatic bar t emplyment. Factrs such as age and time f ffense, seriusness and nature f the vilatin, and rehabilitatin will be taken int accunt. (D nt include minr traffic infractins, and cnvictins fr which the recrd has been sealed r expunged, any cnvictin fr which prbatin has been successfully cmpleted r therwise discharged and the case has been judicially dismissed, referrals t and participatin in any pretrial r pst trial diversin prgrams, and marijuana-related ffenses that ccurred ver tw years ag in answering these questins). Have yu ever pled guilty r n cntest t, r been cnvicted f, a misdemeanr r felny? [ ] Yes [ ] N If yes, please give the date(s) and details: Have yu ever been terminated r asked t resign frm any jb? [ ] Yes [ ] N If yes, please explain circumstances: May we cntact yur current emplyer? [ ] Yes [ ] N -- If n please explain: Please indicate any actual experience, special training and qualificatins that yu have which yu feel are relevant t the psitin fr which yu are applying (use backside f page if needed): Please list any Languages yu speak andr write fluently: Have yu ever used anther name? [ ] Yes [ ] N. If yes, name(s) used: If hired can yu furnish prf that yu are ver 18 years f age? [ ] Yes [ ] N D yu have adequate transprtatin t and frm wrk? [ ] Yes [ ] N Are yu capable f satisfactrily perfrming the essential jb duties required f the psitin fr which yu are applying? [ ] Yes [ ] N If n please explain what duties yu cannt perfrm:_

2 EMPLOYMENT HISTORY Please list the names f yur present r previus emplyers in chrnlgical rder with present r mst recent emplyer listed first. Be sure t accunt fr all perids f time including military service and any perid f unemplyment. If self-emplyed, give firm name and give references. [Please add additinal page(s) if necessary] Present r Mst Recent Emplyer Emplyed Rate f Pay Yur title r psitin Exact Reasn fr Leaving Telephne: ( ) Frm (myr) T (myr) Name and title f yur Last Supervisr: Previus Emplyer Telephne: ( ) Emplyed Frm (myr) T (myr) Rate f Pay Yur title r psitin Name and title f yur Last Supervisr: Exact Reasn fr Leaving Previus Emplyer Telephne: ( ) Emplyed Frm (myr) T (myr) Rate f Pay Yur title r psitin Name and title f yur Last Supervisr: Exact Reasn fr Leaving Previus Emplyer Telephne: ( ) Emplyed Frm (myr) T (myr) Rate f Pay Yur title r psitin Name and title f yur Last Supervisr: Exact Reasn fr Leaving Previus Emplyer Telephne: ( ) Emplyed Frm (myr) T (myr) Rate f Pay Yur title r psitin Name and title f yur Last Supervisr: Exact Reasn fr Leaving Please explain fully any gaps in emplyment histry:

3 EDUCATION Schl Name Highest Year Cmpleted (Please Circle) Diplma Degree Describe Curse f Study r Majr Describe Specialized Training, Experience, Skills and Extra- Curricular Activities Elementary: High Schl: CllegeUniversity GraduatePrfessinal Or Trade r Crrespndence: Other: Is any additinal infrmatin (in relatin t change f name, use f an assumed name, r nickname) necessary t enable a check n yur wrk and educatinal recrd? [ ] Yes [ ] N If yes, please explain: PERSONAL REFERENCES Please list persns wh knw yu well nt previus emplyers r relatives Name Occupatin Address (Street, City and State) Telephne Number Number f Years Knwn THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF THIRTY (30) DAYS. IF YOU WISH TO BE CONSIDERDED FOR EMPLOYMENT AFTER THAT TIME, YOU MUST REAPPLY. In the event f my emplyment t a psitin with Ebix, Inc BPO Divisin - IDS, I will cmply with all f the rules and regulatins f Ebix, Inc. I understand that Ebix, Inc reserves the right t require me t submit t a test f the presence f drugs in my system prir t emplyment, t the extent permitted by law. I als understand that any ffer in emplyment may be cntingent upn passing f a drug test. I understand that I shuld decline t sign this cnsent r take the abve tests, my applicatin fr emplyment may be rejected r my emplyment may be terminated. If hired, I agree as fllws: My emplyment and cmpensatin is terminable at-will, is fr n definite perid, and my emplyment may be terminated by either myself r Ebix, Inc at any time and fr any reasn whatsever, with r withut gd cause. I hereby state that all infrmatin that I have prvided n this applicatin r any ther dcuments cmpleted in cnnectin with my emplyment, andr any infrmatin given in any interview, is true and accurate. I have withheld nthing that wuld, if disclsed, affect this applicatin unfavrably. I understand that if I am emplyed and any infrmatin prvided t Ebix, Inc is fund t be false, r incmplete in any respect, I may be dismissed. I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE AND ACCURATE. Date Signature f Applicant Ebix, Inc prvides equal emplyment pprtunity fr all applicants and emplyees, in accrdance with State and Federal laws. We d nt unlawfully discriminate n the basis f race, religin, gender, natinal rigin, ancestry, age, physical r mental disability, family care status, veteran status, marital status, sexual rientatin, r any ther prtected status.

4 NS SN NDISCLOSURE and AUTHORIZATION TO OBTAIN INFORMATION In cnnectin with my suitability fr emplyment with Ebix, Inc., (herein Cmpany ) r if emplyed, I understand that prir t r at any time after my emplyment cmmences a cnsumer reprt may be requested fr emplyment purpses frm InfLink Screening Services, Inc.,(herein: InfLink ) frm public recrds including; but nt limited t, Scial Security number, mtr vehicle peratin histrydriving recrds, wrkers cmpensatin infrmatin and criminal histry t the extent permitted by law frm varius lcal, state, and federal agencies. Further, I understand that an Experian Emplyment Insight Reprt, Trans Unin Emplyment Credit Reprt r Equifax Persna reprt may be requested. ly, I understand that an Investigative Cnsumer Reprt may be requested and, as required under 606(a)(1) f the federal Fair Credit Reprting Act (FCRA), 15 U.S.C et seq., I understand that this Reprt will include infrmatin as t my character, general reputatin, persnal characteristics, mde f living, wrk habits, perfrmance, experience, alng with reasns fr terminatin f past emplyment, whichever are applicable, btained thrugh persnal interviews with assciates wh have knwledge cncerning such items f infrmatin. I VOLUNTARILY AND KNOWINGLY AUTHORIZE ANY PRESENT OR PAST EMPLOYER OR SUPERVISOR, COLLEGE OR UNIVERSITY OR OTHER INSTITUTION OF LEARNING, ADMINISTRATOR, LAW ENFORCEMENT AGENCY, STATE AGENCY, LOCAL AGENCY, FEDERAL AGENCY, CREDIT BUREAU, PRIVATE BUSINESS, MILITARY BRANCH OR THE NATIONAL PERSONNEL RECORDS CENTER, PERSONAL REFERENCE, ANDOR OTHER PERSONS TO GIVE RECORDS OR INFORMATION THEY MAY HAVE CONCERNING MY CRIMINAL HISTORY, MOTOR VEHICLE HISTORY, SOCIAL SECURITY NUMBER, EARNINGS HISTORY, CHARACTER, AND EMPLOYMENT (INCLUDING REASONS FOR TERMINATION), CREDIT HISTORY, CREDIT CAPACITY, OR CREDIT STANDING OR ANY OTHER INFORMATION REQUESTED BY INFOLINK DEEMED PERTINENT TO MY EMPLOYMENT. In accrdance with the FCRA and applicable state laws, I understand that I have the right t request a cmplete and accurate disclsure f the nature and scpe f the investigatin requested. Further, I am entitled t knw if emplyment is denied because f infrmatin btained by my prspective emplyer frm a Reprting Agency. If s, I will be s advised in writing and be given the name, address and tll free number f the agency, a statement that the actin was based in whle r in part n infrmatin cntained in the Reprt, and written ntice that I have the right (i) if I request, t btain within sixty days a free cpy f the Reprt frm the Reprting Agency (under n circumstances shall such cst exceed the actual csts f duplicatin), and frm any ther Cnsumer Reprting Agency which cmpiles and maintains files n cnsumers n a natinwide basis; and, (ii) t dispute the accuracy r cmpleteness f any infrmatin in a cnsumer reprt furnished by the Reprting Agency. I understand that upn my request with reasnable ntice and after furnishing prper identificatin, InfLink s trained persnnel will prvide me with investigative infrmatin in my file during nrmal business hurs in persn r upn written request, by certified mail t a specified addressee, r telephne as permitted by law. Further, I understand that shuld I wish t review my file in persn; I am permitted t be accmpanied by ne ther persn f my chsing wh shall furnish reasnable identificatin and if requested, InfLink will prvide a written explanatin f any cded infrmatin cntained in my file. I understand that InfLink is a Cnsumer Reprting Agency and it is InfLink s plicy t nt be invlved in r make hiring decisins r recmmendatin. InfLink s privacy plicy limits the infrmatin it prvides t the Cmpany named herein, hwever I hereby authrize the Cmpany t share such infrmatin with parties in interest wh have a need t knw such infrmatin t prtect them and their emplyees. InfLink des nt sell r therwise prvide any f the infrmatin fund in its backgrund investigatins t any ther party ther than the Cmpany. I understand that any cnsumer reprt r investigative cnsumer reprt requested will be used strictly fr emplyment purpses as defined under 603(h) and authrized under 604(a)(3)(B) f the Fair Credit Reprting Act, as a reprt t be used fr the purpse f evaluatin fr emplyment, prmtin, reassignment r retentin as an emplyee. I further understand and cnsent t the furnishing f wrkers cmpensatin infrmatin, after a cnditinal jb ffer, which may include my medical infrmatin including any and all injuries pursuant t state law and in cmpliance with the Federal Americans with Disabilities Act. In additin, I understand that any ffer f emplyment, prmtin, reassignment r retentin will be cnditinal upn the receipt f satisfactry infrmatin as required by the Cmpany, and that t be cnsidered fr emplyment, prmtin, reassignment r retentin, I must authrize the prcurement f such reprt(s). A phtgraphic r faxed cpy f this frm shall be as valid as the riginal. **************************************************************************************************************************************************************** The fllwing must be filled ut cmpletely and signed fr yur applicatin t be cnsidered (Please print) LAST NAME FIRST NAME MIDDLE NAMEINITIAL HOME ADDRESS CITY _ COUNTY STATE ZIP SOCIAL SECURITY NUMBER DRIVER'S LICENSE NUMBER r STATE ID # STATE ISSUED ADDRESS FOR IDENTIFICATION PURPOSES, PLEASE PROVIDE: FULL DATE OF BIRTH HAVE YOU USED ANY NAMES OR SOCIAL SECURITY NUMBERS OTHER THAN ABOVE? Yes N Please List Other Names Used Please List Other SS Number Used (Please sign) Signature Authrizing the Prcurement f the Cnsumer Reprt andr Investigative Cnsumer Reprt TODAY'S DATE I understand that in Califrnia, Minnesta, r Oklahma if a Cnsumer ReprtInvestigative Cnsumer Reprt (including any Credit Reprt) was requested, I may rder a cpy f such reprt and it will be mailed t me: Yes, please send me a cpy f my Reprt 9201 Oakdale Avenue, Suite 100, Chatswrth, CA PHN: (818) 990-HIRE (800) 990-HIRE FAX: (818) InfLink All Rights Reserved (1204 (SFT966C)

5 NS SN INFORMACIÓN LEGAL Y AUTORIZACIÓN PARA OBTENER INFORMACIÓN En relación cn mi abilidad de satisfacer ls requists de emple cn Ebix, Inc. (que de aquí en adelante se denminará Cmpania ), para ser emplead ya cntratad, y entiend que anterirmente a () después de que mi emple cmience, se pdrá slicitar a InfLink Screening Services (que de aquí en adelante se denminará InfLink ) un Reprte de Cnsumidr para fines de emple de ls registrs públics incluyend entre trs, per n limitad a el númer del segur scial, histrial de peración de vehículs mtrizadsexpediente de manejar, infrmación sbre la cmpensación de ls trabajadres y antecedentes pliciales en la medida en que l permita la ley, de las varias agencias lcales, estatales y federales. Además, entiend que se pdrá slicitar un Reprte de crédit, ya sea un Reprte de Infrmación de Emple ( Emplyment Insight Reprt ) de Experian un Reprte de Evaluación Previa de Emple de Trans Unin ( Emplyment Credit Reprt ) Equifax Persna Reprt. mente, entiend que se pdrá slicitar un Reprte de Investigación de Cnsumidr y, cm se requiere de acuerd al 606(A)(1), del Fair Credit Reprting Act del Gviern Federal (FCRA.) Y entiend que este reprte incluirá infrmación cn respect a mi carácter, reputación general, características persnales, md de vida, hábits de trabaj, desempeñ, experiencia, junt cn las raznes de la terminación de mis emples anterires, ls que sean aplicable, que se btengan pr medi de entrevistas persnales cn asciads que tengan cncimient en relación a tales punts de infrmación. YO, VOLUNTARIAMENTE Y A SABIENDAS, AUTORIZO A CUALQUIER EMPRESA O SUPERVISOR ACTUAL O ANTERIOR, A CUALQUIER COLEGIO O UNIVERSIDAD U OTRA INSTITUCION DE APRENDIZAJE; ADMINISTRADOR, AGENCIA POLICIAL, AGENCIA ESTATAL, AGENCIA LOCAL, AGENCIA FEDERAL, OFICINA DE CREDITO; NEGOCIOS PARTICULARES; RAMA MILITAR O CENTRO DE REGISTROS NACIONALES DE PERSONAL, REFERENCIAS PERSONALES, YU OTRAS PERSONAS, A DIVULGAR REGISTROS O INFORMACION QUE PUDIERAN TENER EN RELACION A MIS ANTECEDENTES POLICIALES, A MI HISTORIAL EN EL MANEJO DE VEHICULOS MOTORIZADOS, NUMERO DE SEGURO SOCIAL, HISTORIAL DE INGRESOS, CARACTER Y EMPLEO (INCLUYENDO LAS RAZONES DE LA TERMINACION DEL MISMO) HISTORIAL DE CREDITO, MI CAPACIDAD DE CREDITO O MI SITUACION DE CREDITO O CUALQUIER OTRA INFORMACION PERTINENTE SOLICITADA POR INFOLINK. De acuerd cn el FCRA y el estad de ley, y entiend que teng el derech de slicitar infrmación cmpleta y precisa de la naturaleza y alcance de la infrmación slicitada. Además, teng derech a saber si se me niega el emple debid a infrmación que mi empresa ptencial btenga de la Agencia de Reprtes. De ser así, se me avisará, pr escrit, y se me dará el nmbre y dmicíli de la agencia, inluyend su numer de telefn gratis, declarand que la acción se basó en td en parte, en la infrmación que cntiene el Reprte y ntificación pr escrit de que teng el derech de (i) si yó l slicit, a btener dentr de 60 dias una cpia gratuita del Reprte de la Agencia de Reprtes y de cualquier tra Agencia de Reprtes de crédit de cnsumidres que tenga mantenga expedientes de cnsumidres a nivel nacinal (el cst n debe excidir el cst de las cpias baj ninguna circumstancia); (ii) a disputar que tan precisa cmpleta es la infrmación incluida en un reprte de crédit de cnsumidres entregad pr la Agencia de Reprtes. Entiend que al hacer mi slicitud cn un plaz raznable, y después de prveer la identificación crrespndiente, persnal entrenad de InfLink me prprcinará la infrmación sbre la investigación que se encuentra en mi expediente, durante las hras hábiles nrmales, ya sea en persna pr medi de slicitud pr escrit, pr crre certificad a la direccin especificada, pr teléfn cm l permita la ley. Además entiend, si y l dese, examinar mi expediente persnalmente. Se me permite que y sea acmpañad pr una persna que y seleccine, cn tal que ella prvea identificación rasnable. InfLink prveerá explicación de la infrmación en códig cntenida en el expediente. Y entiend que inflink es una agencia de reprtes de cnsumidr y que es plítica de inflink n participar en tmar decisines hacer recmendacines respect al emple; La plítica de privacdad de InfLink limita la infrmación que prprcina al Cmpania aquí nmbrad; pr este medi autriz al Cmpania a cmpartir tal infrmación cn las partes interesadas que tengan un derech de saber cn el fin de prtegerse a sí mismas y a sus empleads. Inflink n vende, ni prprcina de manera alguna a ninguna tra persna entidad la infrmación que btenga en sus investigacines de antecedents al mens que sea el Cmpania. Entiend que cualquier Reprte de Cnsumidr Reprte de Investigación de Cnsumidr que se slicite, se utilizará estrictamente para fines de emple cm es definid en The Fair Credit Reprting Act (la Ley de Reprtes Justs de Crédit, Párraf 603(h) 604(a)(3)(B) cm un reprte a utilizarse para fines de evaluación para el emple, prmción, reasignación retención cm emplead. Entiend además y dy mi cnsentimient a que se prprcine infrmación sbre el segur de cmpensación de ls trabajadres, después de una ferta cndicinal de emple, que pudiera incluir mi infrmación médica incluyend tdas y cada una de las lesines de acuerd a la ley estatal y en cumplimient cn la Ley Federal de Americans cn Incapacidades. Entiend, además, que cualquier ferta de emple, prmción ó reasignación, será cn la cndicin de que se reciba infrmación satisfactria y para ser cnsiderad para el emple, prmción ó reasignación, debó autrizar la adquisición de tales reprtes. Una cpia ftstática de facsímil de esta Ntificación y Autrización será tan válida cm la riginal. Se le entrega esta versión en españl sl cm una crtesia. Si hubiera alguna ambigüedad en la traducción al españl, regirá la versión en ingles. **************************************************************************************************************************************************************** Para que se cnsidere su slicitud, deberá cmpletar ttalmente y firmar l siguiente (Favr de utilizar letra de imprenta) APELLIDO PRIMER NOMBRE SEGUNDO NOMBRE DOMICÍLIO EN CASA CIUDAD CONDADO ESTADO ZIP NÚMERO DE SEGURO SOCIAL NÚMERO DE LICENCIA DE CONDUCIRST# ESTADO QUE EXPIDIÓ DOMICÍLIO EN CASA PARA FINES DE IDENTIFICACIÓN, FAVOR DE DAR: FECHA DE NACIMIENTO, 20 HA USADO OTROS NOMBRES Ó # DE SEGURO SOCIAL APARTE DE LOS ANTERIORES? Sí N Indique ls nmbres que ha usad Indique trs # de Seg. Scial que ha usad (Favr de firmar) FECHA DE HOY Firma que autriza la Obtención del Reprte de Cnsumidr y El Reprte de Investigación de Cnsumid Esty de acuerd que en Califrnia, Minnesta, Ó en Oklahma si un reprte del cnsumidr (incluyend un reprte de crédit)a sid slicitad púed btener una cpia de tal reprte el cúal será enviad pr crre. Si, Pr favr mande una cpia de mi reprte Oakdale Avenue, Suite 100, Chatswrth, CA PHN: (818) 990-HIRE (800) 990-HIRE FAX: (818) InfLinkTds ls derechs reservads (1104) (SFT966C)

6 A Summary f Yur Rights Under the Fair Credit Reprting Act Para infrmacin en espanl, visite escribe a la FTC Cnsumer Respnse Center, Rm 130-A 600 Pennsylvania Ave. N.W., Washingtn, D.C The federal Fair Credit Reprting Act (FCRA) prmtes the accuracy, fairness, and privacy f infrmatin in the files f cnsumer reprting agencies. There are many types f cnsumer reprting agencies, including credit bureaus and specialty agencies (such as agencies that sell infrmatin abut check writing histries, medical recrds, and rental histry recrds). Here is a summary f yur majr rights under the FCRA. Fr mre infrmatin, including infrmatin abut additinal rights, g t r write t: Cnsumer Respnse Center, Rm 130-A, Federal Trade Cmmissin, 600 Pennsylvania Ave. N.W., Washingtn, D.C Yu must be tld if infrmatin in yur file has been used against yu. Anyne wh uses a credit reprt r anther type f cnsumer reprt t deny yur applicatin fr credit, insurance, r emplyment r t take anther adverse actin against yu must tell yu, and must give yu the name, address, and phne number f the agency that prvided the infrmatin. Yu have the right t knw what is in yur file. Yu may request and btain all the infrmatin abut yu in the files f a cnsumer reprting agency (yur file disclsure ). Yu will be required t prvide prper identificatin, which may include yur Scial Security number. In many cases, the disclsure will be free. Yu are entitled t a free file disclsure if a persn has taken adverse actin against yu because f infrmatin in yur credit reprt; yu are the victim f identify theft and place a fraud alert in yur file; yur file cntains inaccurate infrmatin as a result f fraud; yu are n public assistance; yu are unemplyed but expect t apply fr emplyment within 60 days. In additin, by September 2005 all cnsumers will be entitled t ne free disclsure every 12 mnths upn request frm each natinwide credit bureau and frm natinwide specialty cnsumer reprting agencies. See fr additinal infrmatin. Yu have the right t ask fr a credit scre. Credit scres are numerical summaries f yur credit-wrthiness based n infrmatin frm credit bureaus. Yu may request a credit scre frm cnsumer reprting agencies that create scres r distribute scres used in residential real prperty lans, but yu will have t pay fr it. In sme mrtgage transactins, yu will receive credit scre infrmatin fr free frm the mrtgage lender. Yu have the right t dispute incmplete r inaccurate infrmatin. If yu identify infrmatin in yur file that is incmplete r inaccurate, and reprt it t the cnsumer reprting agency, the agency must investigate unless yur dispute is frivlus. See fr an explanatin f dispute prcedures. Cnsumer reprting agencies must crrect r delete inaccurate, incmplete, r unverifiable infrmatin. Inaccurate, incmplete r unverifiable infrmatin must be remved r crrected, usually within 30 days. Hwever, a cnsumer reprting agency may cntinue t reprt infrmatin it has verified as accurate. Cnsumer reprting agencies may nt reprt utdated negative infrmatin. In mst cases, a cnsumer reprting agency may nt reprt negative infrmatin that is mre than seven years ld, r bankruptcies that are mre than 10 years ld. Access t yur file is limited. A cnsumer reprting agency may prvide infrmatin abut yu nly t peple with a valid need -- usually t cnsider an applicatin with a creditr, insurer, emplyer, landlrd, r ther business. The FCRA specifies thse with a valid need fr access. Yu must give yur cnsent fr reprts t be prvided t emplyers. A cnsumer reprting agency may nt give ut infrmatin abut yu t yur emplyer, r a ptential emplyer, withut yur written cnsent given t the emplyer. Written cnsent generally is nt required in the trucking industry. Fr mre infrmatin, g t

7 Yu may limit prescreened ffers f credit and insurance yu get based n infrmatin in yur credit reprt. Unslicited prescreened ffers fr credit and insurance must include a tll-free phne number yu can call if yu chse t remve yur name and address frm the lists these ffers are based n. Yu may pt-ut with the natinwide credit bureaus at OPTOUT ( ). Yu may seek damages frm vilatrs. If a cnsumer reprting agency, r, in sme cases, a user f cnsumer reprts r a furnisher f infrmatin t a cnsumer reprting agency vilates the FCRA, yu may be able t sue in state r federal curt. Identity theft victims and active duty military persnnel have additinal rights. Fr mre infrmatin, visit States may enfrce the FCRA, and many states have their wn cnsumer reprting laws. In sme cases, yu may have mre rights under state law. Fr mre infrmatin, cntact yur state r lcal cnsumer prtectin agency r yur state Attrney General. Federal enfrcers are: TYPE OF BUSINESS: Cnsumer reprting agencies, creditrs and thers nt listed belw Natinal banks, federal branchesagencies f freign banks (wrd Federal r initials F.S.B. appear in federal institutin s name) Federal Reserve System member banks (except natinal banks, and federal branchesagencies f freign banks) Savings assciatins and federally chartered savings banks (wrd Federal r initials F.S.B. appear in federal institutin s name) Federal credit unins (wrds Federal Credit Unin appear in institutin s name) State-chartered banks that are nt members f the Federal Reserve System Air, surface, r rail cmmn carriers regulated by frmer Civil Aernautics Bard r Interstate Cmmerce Cmmissin Activities subject t the Packers and Stckyards Act, 1921 CONTACT: Federal Trade Cmmissin: Cnsumer Respnse Center FCRA Washingtn, DC Office f the Cntrller f the Currency Cmpliance Management, Mail Stp 6-6 Washingtn, DC Federal Reserve Bard Divisin f Cnsumer& Cmmunity Affairs Washingtn, DC Office f Thrift Supervisin Cnsumer Cmplaints Washingtn, DC Natinal Credit Unin Administratin 1775 Duke Street Alexandria, VA Federal Depsit Insurance Crpratin Cnsumer Respnse Center, 2345 Grand Avenue, Suite 100 Kansas City, MO Department f Transprtatin, Office f Financial Management Washingtn, DC Department f Agriculture Office f Deputy Administratr GIPSA Washingtn, DC