AUTHORITY: WV Code and ; ACA Standard

Transcription

1 STATE OF WEST VIRGINIA DIVISION OF CORRECTIONS POLICY DIRECTIVE NUMBER: DATE: SUBJECT: Pre-Employment Background Investigations AUTHORITY: WV Code and ; ACA Standard I. POLICY: It is the policy of the West Virginia Division of Corrections (hereinafter referred to as Division ) to maintain a mechanism that ensures the completion of Pre-Employment/Post-Employment (90-day conditional offer of employment for Correctional Officer classification will complete post-employment) background investigations on all persons applying and being considered for positions within the Division. II. CANCELLATION: Policy Directive , dated 01 June 2008 III. DEFINITIONS: None IV. APPLICABILITY: All units within the Division of Corrections V. PROCEDURE: A. A Pre-Employment Background Investigation may be performed on persons being considered for employment with the Division. B. At the institutions/facilities/centers discretion, additional information may be collected on persons being considered for employment with the Division provided the information is within the scope of Section V-C-6. C. It is mandatory that all hiring authorities use the same format; therefore, the following forms will be utilized: 1. Cover Sheet (Attachment #1): A Cover Sheet for the entire package, indicating whether the applicant is suitable for employment shall be completed by the Human Resources/Payroll Department at the conclusion of the hiring process. 2. Background Investigation Applicant Authorization (Attachment #2): Applicant shall sign authorization for a complete background investigation to be conducted to include criminal history, employment history, education, and any other area(s) deemed necessary or appropriate. Authorization includes language pertaining to a ninety (90) day Conditional Offer of Employment for Correctional Officers.

2 Page 2 of 2 3. Correctional Officer Conditions of Employment (Attachment #3): Applicant shall sign acknowledgment of conditions that must successfully be met in order to be considered for employment as a Correctional Officer. It must be made clear to the applicant that the Conditions of Employment for Correctional Officer must be met or the employee will be dismissed from employment during his/her first ninety (90) days of employment. No conditional offers of employment shall be extended to non-uniformed personnel. 4. Conditions of Employment for Non-Uniformed Positions (Attachment #4): Applicant shall sign acknowledgment of conditions that must successfully be met in order to be considered for employment as a Non-Uniformed staff member. 5. Statement of Informed Consent Correctional Officer (Attachment #5): A Correctional Officer applicant shall sign a Psychological Assessment Consent including a waiver of any rights to obtain and review a copy of the assessment report. 6. Authority to Release Information (Attachment #6): Applicant shall sign a release for the institution/facility/center to request a consumer report which may include information from personal interviews, character, general reputation, personal characteristics, and mode of living, as well as public and private sources including, but not limited to, acquisition of criminal records, employment records, school records, driving records, credit reports, or abstracts, etc. 7. A Summary of Your Rights Under the Fair Credit Reporting Act (Attachment #7): Applicant shall receive a copy when signing Attachment #6 and again, if an adverse action is going to be taken upon completion of the hiring process (i.e., negative results, no conditional offer of employment will be granted). 8. Employment Reference (Attachment #8): To be completed and returned by the organization authorized to complete background research on employment candidates. 9. Confidentiality Statement (Attachment #9): To be completed by personnel authorized by the Appointing Authority to request and maintain records relating to the Fair Credit Reporting Act and background information. 10. Pre-Adverse Action Letter (Attachment #10): To be completed and mailed to applicant/employee prior to adverse action taking place due to consumer report results.

3 Page 3 of Adverse Action Letter (Attachment #11): To be completed and mailed to the applicant/employee upon completion of adverse action. D. When completing this background investigation, the employee authorized to release information shall provide the vendor contracted to complete background investigations with the completed Authority To Release Information Form on each candidate for which a background investigation is requested. All additional information needed by the vendor to complete the background investigation shall be provided when possible (i.e., previous employers, addresses, etc.). When completing this background investigation, at least five (5) former employers shall be contacted. If the candidate does not have five (5) previous employers, a combination of employer and personal contacts shall be made to equal the necessary five (5). D. The contracted vendor shall provide the results of the background investigation to include at least three (3) attempted contacts with previous employers. E. All negative contacts shall be reviewed with the Warden/Administrator or Appointing Authority by the Human Resources Manager or designee. F. A Pre-Adverse Action Notice shall be mailed to an applicant or employee in the case where a conditional offer of employment has been granted, prior to any adverse action being taken against an applicant/employee based in whole or in part on the information obtained in a consumer report. G. An Adverse Action Notice (Attachment #11) shall be mailed to an applicant/ employee after an adverse action is taken based in whole or in part on the information obtained in a consumer report (e.g., request applicant s name be removed from Division of Personnel register, etc.). A Summary of Your Rights Under the Fair Credit Reporting Act shall be included with the Adverse Action Notice. APPROVED SIGNATURE: Jim Rubenstein, Commissioner Date

4 STATE OF WEST VIRGINIA DIVISION OF CORRECTIONS Applicant Background Investigation Cover Sheet Policy Directive Attachment #1 Name of Applicant: Date: Report Made By (Printed Name and Title): N.C.I.C. Criminal Background [ ] Recommend Check Results [ ] Not Recommend Date Received Psychological Testing [ ] Recommended (Where Required) [ ] Not Recommended Date Pre-Agility Examination [ ] Recommend (Where Required) [ ] Not Recommended Date Physical Agility [ ] Pass (Where Required) [ ] Fail Date Valid Driver s License [ ] Yes (Where Required) [ ] No Date Verified Fingerprint Results [ ] Eligible for Employment All Applicants [ ] Ineligible for Employment Date Received Background Investigation [ ] Acceptable All Applicants [ ] Unacceptable Date Received Selective Service Registration [ ] Registered (Where Required) [ ] Not Registered Suitable for Employment Not Suitable For Employment EMPLOYMENT OFFER MADE? YES NO CONDITIONAL OFFER MADE? (Correctional Officer Only) YES NO DATE EMPLOYED [If applicable] Signature of Reporting Employee

5 SAMPLE PRE-ADVERSE ACTION NOTICE Policy Directive Attachment #10 Date Consumer (Job Applicant) Address Dear Consumer: You recently applied and interviewed for employment with the West Virginia Division of Corrections. A decision based in whole or in part on the information obtained in a consumer report prepared by Employment Record Services (ERS Hire Inc) will be made in the near future. In compliance with Section 604(b) of the Fair Credit Reporting Act, you have the right to review the report provided and correct any inaccuracies. Even if the report is correct, you may provide us with an explanation of any negative information. If you wish to do so, please provide any explanation within ten (10) days of the date of this letter. In addition, A Summary of Your Rights Under the Fair Credit Reporting Act is being provided to you. To correct any information please contact: Employment Record Services PO Box Fairfield, NJ You have a right under federal law to obtain a free copy of your consumer report directly from the agency listed above if you make the request within the next sixty (60) days. You may dispute with the consumer credit reporting agency the accuracy or completeness of any information in its report. Their toll free telephone number is You should be aware that the consumer credit reporting agency will not make any decision with regard to your employment with the Division of Corrections. Sincerely, Name Title Enclosure

6 Attachment #11 SAMPLE ADVERSE ACTION NOTICE Date Consumer (Job Applicant) Address Dear Consumer: Based in whole or in part on information obtained in a consumer report prepared by Employment Record Services (ERS Hire Inc), we regret to inform you that we cannot offer you the position for which you have applied or continue your employment in the position in which you were conditionally hired, whichever the case may be. ERS Hire Inc. did not make this decision and is unable to provide specific reasons why this decision was made. In compliance with Section 615 of the Fair Credit Reporting Act, you have the right to request a free copy of the consumer report within sixty (60) days and the right to dispute the accuracy or completeness of any information in the consumer report. To obtain a free copy of the consumer report, please contact: Employment Record Services PO Box Fairfield NJ Their toll free telephone number is Sincerely, Name Title

7 Attachment #2 State of West Virginia DIVISION OF CORRECTIONS Background Investigation Applicant Authorization I,, do hereby affirm the information supplied by me on the Employment Application, during the Interview(s), Pre-Agility Exam (Correctional Officer positions only), and all other selection processes is true and complete. I also do hereby acknowledge that I understand a Background Investigation will be made in the following areas: Criminal History A criminal record check will be conducted utilizing N.C.I.C. and other sources, including fingerprinting, to ascertain whether there are criminal convictions which have a specific relationship to job performance. A criminal record does not automatically exclude an applicant from consideration from employment. Factors such as age at the time of offense, seriousness, nature of the violation and rehabilitation will be taken into account. Applicants for Correctional Officer positions must be able to possess a weapon in the State of West Virginia. Employment History Verification of previous employers as listed on the application and reference requests completed by those employers. Education Verification of education and training information. Any other work-related area deemed necessary or appropriate as the investigation progresses. The Division of Corrections reserves the right to verify any information provided on the Employment Application during the interview and any other information obtained during the selection process. I understand that if I wish to challenge the accuracy and/or completeness of information provided by the West Virginia State Police, Federal Bureau of Investigation or other entities reporting information, I must appeal to the law enforcement agency or other entity providing the information. I hereby declare that the answers to the questions on my application and related paper work which I have completed, and any attachments to same, are true, complete, and accurate to the best of my knowledge and belief. I understand that any misstatements of fact(s) or omissions may form the basis for rejection of my application or for my dismissal after employment. CORRECTIONAL OFFICER POSITIONS ONLY: Furthermore, I also understand that I may be offered employment on a conditional basis not to exceed ninety (90) days while the information I have supplied is verified. I fully understand that the terms of this document must be satisfactorily met in order for me to continue employment after an initial ninety (90) day period. If any material misrepresentations have been made, I understand that I will be separated from employment with the Division of Corrections. This initial ninety (90) day employment also counts toward completion of my probationary period. Applicant s Signature and Date Witness Signature and Date

8 DIVISION OF CORRECTIONS CORRECTIONAL OFFICER CONDITIONS OF EMPLOYMENT Policy Directive Attachment #3 Page 1 of 1 1. Satisfactorily complete an initial interview. 2. Satisfactorily complete a psychological examination. 3. Satisfactorily complete a pre-agility examination. 4. Satisfactorily complete an initial physical performance/agility test. 5. Satisfactorily complete a chemical urinalysis drug-screening test, as required. 6. Character and suitability for employment verified through an agency investigation. 7. Possess a valid driver s license. 8. Successfully complete orientation training. 9. Successfully complete annual Tuberculin PPD test. 10. Successfully complete annual in-service training. 11. Successfully complete specialized training. 12. Successfully complete a formal West Virginia Corrections Academy Basic Training Program. 13. Successfully complete a twelve (12) month probationary period. 14. Subject to mandatory overtime requirements and must be available for assignment to any location in the State of West Virginia. 15. Required to work various shifts and schedules are subject to change at any time. EXCLUSION FROM EMPLOYMENT AUTOMATIC REJECTIONS 1. Prior dismissals from State Government 2. Lying on any Official Application or Employment Document or Interview 3. At least three (3) former employers state that the applicant would not be re-hired 4. Failure to meet minimum requirements of the specified Job Title, e.g. a. Pre-Employment Drug Screening b. Pre-Agility Exam c. Physical Performance/Agility Test d. Psychological Assessment for Job Suitability e. Valid Driver s License (Job Specific) f. Education and/or Experience Requirements If the applicant fails to authorize, complete or cooperate with the background investigation process then the application is considered incomplete and withdrawn. The application is void, no suitability determination is made and there is no right to an appeal. Circumstances which constitute a discontinuance or failure to cooperate and result in the application being withdrawn include but are not limited to: 1. Refusal to fully complete and sign a release and/or waiver 2. Refusal to be fingerprinted 3. Failure to respond within ten (10) calendar days to a request for any required information 4. Failure to report a citation or arrest for an infraction that occurs after a conditional offer of employment has been made and during the background investigation process 5. Omission of required information pertaining to prior criminal convictions 6. Withdrawal of the application or the applicant cannot be located or contacted, or 7. Disqualification or determination of ineligibility for reasons other than the background investigation

9 Attachment #3 Page 2 of 2 I have read and understand the conditions of employment as a Correctional Officer with the West Virginia Division of Corrections. I further understand that if I do not meet all of the minimum requirements listed above, I will not be eligible for employment or a conditional offer of employment will become invalid and I will be dismissed from employment. Date Applicant s Signature Date Witness Signature To be signed by the applicant. Keep with Pre-Employment Background Investigation. cc: Applicant

10 Attachment #4 Page 1 of 1 DIVISION OF CORRECTIONS NON-UNIFORMED POSITIONS CONDITIONS OF EMPLOYMENT 1. Satisfactorily complete an initial interview. 2. Satisfactorily complete a chemical urinalysis drug-screening test, as required. 3. Character and suitability for employment verified through an agency investigation. 4. Possess a valid driver s license. 5. Successfully complete orientation training. 6. Successfully complete annual in-service training. 7. Successfully complete specialized training. 8. Successfully complete a formal West Virginia Corrections Academy Basic Training Program. 9. Successfully complete a six (6) month probationary period. 10. Subject to mandatory overtime requirements and must be available for assignment to any location in the State of West Virginia. 11. Required to work various shifts and schedules are subject to change at any time. EXCLUSION FROM EMPLOYMENT AUTOMATIC REJECTIONS 1. Prior dismissals from State Government. 2. Lying on any Official Application or Employment Document or Interview. 3. At least three (3) former employers state that the applicant would not be re-hired. 4. Failure to meet minimum requirements of the specified Job Title, e.g. a. Pre-Employment Drug Screening b. Valid Driver s License (Job Specific) c. Education and/or Experience Requirements If the applicant fails to authorize, complete, or cooperate with the background investigation process then the application is considered incomplete and withdrawn. The application is void, no suitability determination is made, and there is no right to an appeal. Circumstances which constitute a discontinuance or failure to cooperate and result in the application being withdrawn include, but are not limited to: 1. Refusal to fully complete and sign a release and/or waiver 2. Refusal to be fingerprinted 3. Failure to respond within ten (10) calendar days to a request for any required information 4. Failure to report a citation or arrest for an infraction that occurs after a conditional offer of employment has been made and during the background investigation process 5. Omission of required information pertaining to prior criminal convictions 6. Withdrawal of the application or the applicant cannot be located or contacted, or 7. Disqualification or determination of ineligibility for reasons other than the background investigation

11 Attachment #4 Page 2 of 2 I have read and understand the conditions of employment as a non-uniformed employee with the West Virginia Division of Corrections. I further understand that if I do not meet all of the minimum requirements listed above, I will not be eligible for employment or a conditional offer of employment will become invalid and I will be dismissed from employment. Date Applicant s Signature Date Witness Signature To be signed by the applicant. Keep with Pre-Employment Background Investigation. cc: Applicant

12 Attachment #5 STATEMENT OF INFORMED CONSENT CORRECTIONAL OFFICER The West Virginia Division of Corrections evaluates several factors, which may include an applicant s experience, education and job history, ability to pass a urine screen, ability to pass a physical agility test, background checks from a variety of sources, psychological assessment, and one or more personal interviews before making decisions to employ an applicant or not. The first step in this process is a personal interview. Recommendations will then be made as to which applicants shall receive further consideration. Those selected for further consideration will continue with the screening process, including the completion of a psychological assessment instrument. Please be informed the information obtained during the psychological assessment instrument is confidential. The results of the psychological assessment is the property of the West Virginia Division of Corrections and is considered as proprietary information and will not be shared with the applicant. YOUR SIGNATURE INDICATES THAT YOU WAIVE ANY RIGHTS TO OBTAIN AND REVIEW A COPY OF THE PSYCHOLOGICAL ASSESSMENT REPORT. If you are notified by the West Virginia Division of Personnel that your name is removed from the Personnel s Certification of Eligibility Listings (Civil Service Registers) because of your completion of the psychological assessment and not meeting standards that we consider as being essential to the employment process, you can appeal that determination within fifteen (15) calendar days of notification, in writing, to: Director of Human Resources 1409 Greenbrier Street Charleston, West Virginia Your signature below is attestation that you fully understand this document and consent to the conditions stated above and your initials indicate you were given a copy of this document. (Applicant s Name Printed) (Signature) (Witness Name Printed) (Witness Signature) XXX-XX- Last 4 Digits of Social Security Number (Date) (Title) (Date) I received a copy of this document (Initial) (Witness) (Date)

13 WEST VIRGINIA DIVISION OF CORRECTIONS AUTHORITY TO RELEASE INFORMATION Policy Directive Attachment #6 TO: Any person having knowledge of my conduct or activities, or any past, present or future Employer, Credit Bureau, Bank, Financial Institution, Dean, Registrar, Principal, Counselor, Instructor, or School, Doctor, Hospital, Clinic or Medical Facility, Law Enforcement Agency, Government Agency or Armed Forces: I,, hereby authorize the Division of Corrections and/or its agents, to conduct an appropriate background investigation of me and prepare a consumer report or investigative consumer report which may be used as a factor in determining my eligibility for employment, promotion, or retention as governed by the Fair Credit Reporting Act Public Law I understand this report may include information from personal interviews about my character, general reputation, personal characteristics, and mode of living as well as public and private sources including, but not limited to, the acquisition of criminal records, employment records, school records, driving records, or abstracts, etc. I further understand the report may contain information about social security number verification, driving records, Uniform Commercial Code (UCC) filings, any liens or judgments, and bankruptcies as a result of a public record(s) search from any federal, state, or any other agency which might contain such records. Information contained in my credit report may be used as a factor in any employment decision for specific public trust positions. I authorize all persons who may have information relevant to this investigation to disclose it to the Division of Corrections and/or its agents, and I release all persons from any liability on account of such disclosure. I acknowledge that I have carefully read and fully understand the provisions of this release. I further acknowledge that I was given the opportunity to consult with an attorney or any other individual of my choosing before signing this release and that I have decided to sign this release voluntarily and without coercion or duress by any person. This release sets forth the entire agreement between your organization and me, and I acknowledge that I have not relied upon any representation or statement, written or oral, not set forth in this document in executing this release. I hereby waive any privilege of confidentiality with respect to any such information. I hereby further authorize that a photocopy of this authorization may be considered as valid as an original. Please provide the requested information within ten (10) days of the date of this letter so that I may receive further consideration for employment. Signature: Date: Furnished for the purpose of positive identification: (Print Clearly) Last: First: MI: Address: City: State: Zip: A.K.A. (include Maiden Name): SSN: - - DOB: / / Driver s License #: State: Address History: [Past seven (7) years]

14 Attachment #7 Page 1 of 1 A Summary of Your Rights Under the Fair Credit Reporting Act 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 CRAs are credit bureaus that gather and sell information about you -- such as if you pay your bills on time or have filed bankruptcy -- to creditors, employers, landlords, and other businesses. You can find the complete text of the FCRA, 15 U.S.C u, at the Federal Trade Commission's web site ( The FCRA gives you specific rights, as outlined below. You may have additional rights under state law. You may contact a 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 also are 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 CRA. If 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 your 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 CRA 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 your 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

15 reinsert into your file a disputed item unless the information source verifies its accuracy and completeness. In addition, the CRA must give you a written notice telling you it has reinserted the item. The notice must include the name, address and phone number of the information source. Policy Directive Attachment #7 Page 2 of 2 You can dispute inaccurate items with the source of the information. If you tell anyone -- such as a creditor who reports to a CRA -- that you dispute an item, they may not then report the information to a CRA without including a notice of your dispute. In addition, once you've 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 may 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, or 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 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 unsolicited offers of credit or insurance. Such offers must include a toll-free phone 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 of CRA data, violates the FCRA, you may sue them in state or federal court. The FCRA gives several different federal agencies authority to enforce the FCRA: FOR QUESTIONS OR CONCERNS REGARDING: PLEASE CONTACT: CRAs, creditors and others not listed below Federal Trade Commission Consumer Response Center - FCRA Washington, DC

16 Attachment #7 Page 3 of 3 National banks, federal branches/agencies of foreign banks (word "National" or initials "N.A." appear in or after bank's name) Office of the Comptroller of the Currency Compliance Management, Mail Stop 6-6 Washington, DC Federal Reserve System member banks (except national banks, and federal branches/agencies of foreign banks) Federal Reserve Board Division of Consumer & Community Affairs Washington, DC Savings associations and federally chartered savings banks (word "Federal" or initials "F.S.B." appear in federal institution's name) Office of Thrift Supervision Consumer Programs Washington, DC Federal credit unions (words "Federal Credit Union" appear in institution's name) National Credit Union Administration 1775 Duke Street Alexandria, VA State-chartered banks that are not members of the Federal Reserve System Federal Deposit Insurance Corporation Division of Compliance & Consumer Affairs Washington, DC FDIC Air, surface, or rail common carriers regulated by former Civil Aeronautics Board or Interstate Commerce Commission Department of Transportation Office of Financial Management Washington, DC Activities subject to the Packers and Stockyards Act, 1921 Department of Agriculture Office of Deputy Administrator - GIPSA Washington, DC

17 Attachment #8 Page 1 of 2 West Virginia Division of Corrections Applicant Employer Reference Interview File No: Attention: Date: Fax No:, SSN: is applying for a job with the West Virginia Division of Corrections and states he/she worked for you or your organization. The following information is required in order to further evaluate this applicant. Attached is an authorization to release and release of liability. Please complete and return this form at your earliest convenience. Our toll free fax: or mail to: West Virginia Dept of Corrections c/o Employment Record Services PO Box Fairfield NJ Please provide the following information. a. Name of Employer: b. Dates of Employment: FROM TO c. Position for which initially employed: d. Last position held: e. Description of job duties and responsibilities: f. Is individual still employed: YES NO g. If not still employed, reason individual left your employment: h. Please have completed by immediate supervisor if still employed, or by personnel office, if supervisor is no longer with company. Excellent Good Average Fair Poor Quality of work Quantity of work Attendance & Punctuality Conduct Ability to work with others Honesty/Integrity Ability to work with Supervisors/Management Please comment on any rating of Poor, and feel free to comment on any area rated better than Average. Comments may be made on a separate sheet or on the reverse side of this letter. Would you re-employ: YES NO If no, please explain: Completed by: [NAME] [Job Title (if applicable)] Signature: Date: Phone Number:

18 Attachment #8 Page 2 of 2 West Virginia Division of Corrections Applicant Reference Interview File No: Attention: Date: Fax No:, SSN: is applying for a job with the West Virginia Division of Corrections and has given your name as a reference. The following information is required in order to further evaluate this applicant. Attached is an authorization to release and release of liability. Please complete and return this form at your earliest convenience. Our toll free fax: or mail to: Personal/Academic/Volunteer Work Reference West Virginia Dept of Corrections c/o Employment Record Services PO Box Fairfield NJ a. Dates you have known applicant: FROM TO b. How were you associated with the applicant (friend, neighbor, teacher, volunteer coordinator)? c. Based on the association you have had with the applicant, please describe the characteristics of the applicant which, in your opinion, you think would help him/her succeed in this position or would be an asset to this agency should an employment offer be made. Completed by: Name: Job Title (if applicable): Signature: Date: Phone Number:

19 West Virginia Division of Corrections Access Security and Confidentiality Requirements Policy Directive Attachment #9 Page 1 of 1 Confidential Information The Employee acknowledges in any position the Employee may hold, in and as a result of the Employee's employment by the Employer, the Employee will, or may, be making use of, acquiring or adding to information about certain matters and things which are confidential to the Employer and which information is the exclusive property of the Employer, including, without limitation: Confidential Information means all data and information relating to the business and management of the Employer, including, but not limited to, accounting records to which access is obtained by the Employee, including Business Operations, Computer Software, Computer Technology, and Personnel Records. Confidential Information will also include any information which has been disclosed by a third party to the Employer and governed by a non-disclosure agreement entered into between the third party and the Employer. Confidentiality Obligations 1. The Employee shall not use confidential information for any purpose except to perform job duties for the Employer. 2. The Employee shall not use confidential information for his or her private gain or the private gain of another. 3. The Employee shall protect confidential information from unauthorized use, transfer, sale, disclosure, alteration, or destruction whether accidental or intentional and will take necessary precaution to secure such information located at my work station. 4. The Employee shall adhere to the computer security practices as set forth in Policy Directive to ensure that confidential information is not disclosed to persons who have not been authorized to access such information by the Employer. The Employee will protect passwords and access codes from disclosure and will avoid using easily guessed passwords or passwords that have a personal meaning (e.g., a spouse's name or a child's name). 5. The Employee shall immediately report any incident that appears to compromise data security or confidentiality to his or her immediate supervisor. 6. The Employee s access to confidential information, if granted, is at the sole discretion of the Employer and such access may be modified, suspended, or terminated at any time by the Employer. 7. Immediately upon expiration or termination of the Employee s employment with the Employer, the Employee shall promptly return, without copying or summarizing, all confidential information and take whatever other lawful steps required by the Employer to protect the confidential information. 8. The Employee will not be involved in any way with the processing of employment documentation for relatives, friends or acquaintances. The term "friend" means a person whom the Employee knows, likes, and trusts (American Heritage Dictionary definition). An "acquaintance" is a person whom one knows but who is not a particularly close friend.

20 Access Security Requirements Consumer Reports Policy Directive Attachment #9 Page 2 of 2 The Employer and Employee are charged with the responsibility to protect the privacy of consumers. The following measures are designed to reduce unauthorized access of consumer credit reports. In accessing consumer credit services, the Employee agrees to follow these measures. 1. Protect assigned account number and password so that only authorized personnel have knowledge of this sensitive information. Unauthorized persons should never have knowledge of account numbers and passwords. Such information shall not be posted in any manner within the facility. 2. Do not discuss account number and password by telephone with any unknown caller, even if the caller claims to be an employee of the credit provider. 3. Ensure that all terminal devices used to obtain credit information are located in a secure location within the facility with restricted access. 4. After normal business hours, ensure all devices used to obtain credit information are turned off and systems locked. 5. Secure hard copies and electronic files of consumer reports so that an unauthorized person cannot easily access them. 6. Shred or destroy all hard copy consumer reports when no longer needed. 7. Erase and overwrite or scramble electronic files containing consumer information when no longer needed and when applicable regulation(s) permit destruction. 8. Access credit information only for the permissible purposes listed in the Permissible Purpose Information section of the membership application. Employees shall not access their own reports or the reports of relatives, friends, or acquaintances. Record Retention: Credit applications are to be retained for a reasonable period of time. Such records shall facilitate the investigative process if a consumer claims that the Employer or Employee inappropriately accessed his/her credit report. [Note: The Federal Equal Credit Opportunity Act states that a creditor must preserve all written or recorded information connected with an application for twenty-five (25) months]. Under Section 621 (a) (2) (A) of the Federal Fair Credit Reporting Act (FCRA), any person that violates any of the provisions of the FCRA may be liable for a civil penalty of not more than $2,500 per violation. I agree to implement and adhere to the above controls. I understand that the Code of West Virginia, as amended, provides penalties for the unlawful release of privileged information. Depending upon the severity of the breach of confidentiality, disciplinary action could result in an oral or written reprimand, suspension, demotion or dismissal. Violations could also result in civil or criminal prosecution. By signing this document, I acknowledge that these statements have been explained to me and that I have read the statements included herein. I also acknowledge that I have had ample opportunity to ask any questions that I may have regarding this matter. Signature Date