Application

TO BE USED BY ORGANIZATIONS USING CONSUMER REPORTING AGENCIES TO CONDUCT CORI CHECKS FOR EMPLOYMENT, VOLUNTEER, SUBCONTRACTOR, LICENSING, AND HOUSING PURPOSES. Bay Contracting Inc. is registered under the provisions of M.G.L. .c 6, § 172 to receive CORI for the purpose of screening current and otherwise qualified prospective employees, subcontractors, volunteers, license applicants, current licensees, and applicants for the rental or lease of housing. Signer has authorized Bay Contracting Inc. to submit CORI checks to the Massachusetts Department of Criminal Justice Information Services (DCJIS) on its behalf. As a prospective or current employee, subcontractor, volunteer, license applicant, current licensee, or applicant for the rental or lease of housing, I understand that a CORI check will be submitted for my personal information to the DCJIS. I hereby acknowledge and provide to submit a permission to Bay Contracting Inc. CORI check for my information to the DCJIS. This authorization is valid for one year from the date of my signature. I may withdraw this authorization at any time by providing Bay Contacting Inc. with written notice of my intent to withdraw consent to a CORI check. I also understand that this form is a CORI acknowledgement form and I am entitled to additional consumer reporting disclosure forms under the Fair Credit Reporting Act. fI I have not received those disclosures, I should contact Bay Contracting Inc. to request this information. FOR EMPLOYMENT, VOLUNTEER, AND LICENSING PURPOSES ONLY: Bay Contracting Inc. may conduct subsequent CORI checks within one year of the date this Form was signed by me provided,

application form

Bay Contracting Inc. hires candidates to fill positions in masonry, waterproofing, and construction labor.

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