Paycom Payroll, LLC

BACKGROUND SCREENING REPORT 7501 W. Memorial Rd

Prepared for: SCHUTZ CONTAINER SYSTEMS INC Oklahoma City, OK 73142
800-580-4505

Subject Information: Requestor Information:

Subject: EVENS MONARGENT

DOB: 06/01/XXXX
Social Security Number: XXX-XX-6796 Billing Identifier 1: 0L511
Order Number(s): 3023347 Billing Identifier 2: ev66858f6ef3f87
Address: 1122 TUPELO CHASE CT
Billing Identifier 3: 0L520
AUBURN GA 30011
US
Report Disposition negative-dilute

Report Summary Information:

Component Status Last update

National Criminal Scan for EVENS MONAR- COMPLETE 7/03/24 01:01 PM Central
GENT, page 2
County Criminal Search in BARROW county COMPLETE - clear 7/03/24 03:16 PM Central
Georgia for EVENS MONARGENT, page 2
National Sex Offender Registry for EVENS COMPLETE - clear 7/03/24 07:34 PM Central
MONARGENT, page 2
Office of Foreign Assets Control Search, page COMPLETE - clear 7/03/24 01:01 PM Central
2
SSN Check for SSN XXX-XX-6796, page 2 COMPLETE - clear 7/03/24 01:01 PM Central
Non-DOT 5 Panel Drug Test Non-DOT Physical COMPLETE - negative-dilute 7/11/24 12:10 PM Central
and Aud for EVENS MONARGENT, page 2

Notice : The information provided is a consumer report as defined in the federal Fair Credit Reporting Act [15 U.S.C. 1681-
1681u]. It contains confidential information on the individual named. It is submitted to the conditions contained in your
Subscriber Agreement with Paycom Payroll, LLC and may be used solely as a factor in evaluating the named individual for
property renting/leasing, employment, promotion, reassignment or retention as an employee. Paycom Payroll, LLC maintains
strict procedures designed to ensure that the information is complete and up to date. While the information furnished is from
reliable sources, its accuracy is not guaranteed. Proper use of this report and final verification of the named individual’s identity
is your sole responsibility. If any adverse action is taken based in whole or in part on this consumer report, a copy of this report
and a summary of the consumer’s rights must be provided to the consumer prior to taking adverse action.

1
Paycom Payroll, LLC

National Criminal Scan for EVENS MONARGENT COMPLETE :

Completed

County Criminal Search in BARROW county Georgia for EVENS MONARGENT COMPLETE - clear :

No Reportable Records Found

National Sex Offender Registry for EVENS MONARGENT COMPLETE - clear :

No Reportable Records Found

Office of Foreign Assets Control Search COMPLETE - clear :

The subject’s last name was compared against the United States Department of Treasury Specially Designated Nationals and
Blocked Person List and no match was found.

SSN Check for SSN XXX-XX-6796 COMPLETE - clear :

UNABLE TO DETERMINE THE STATE AND YEAR

OF ISSUANCE DUE TO SSN RANDOMIZATION.
PLEASE CLICK THIS LINK FOR FURTHER DETAILS:
HTTPS://WWW.SSA.GOV/EMPLOYER/RANDOMIZATION.HTML

Non-DOT 5 Panel Drug Test Non-DOT Physical and Aud for EVENS MONARGENT COMPLETE - negative-dilute :

Overall Result negative-dilute

--------------------------------------------------------------------------------
Test Type D2UFLQDf628844N
Test Package 5UAUDNPHY
Donor Name EVENS MONARGENT
SSN XXX-XX-6796
Other ID 22966712
Reason For Test PRE-EMPLOYMENT
Collection Date 2024-07-05
Specimen Id CC15813445
Lab Name Quest Diagnostics
Lab Account 11754491
Location Code 647762
Reference ID 2024070316771
Comments DILUTE SPECIMEN
Combined Result NEGATIVE-DILUTE
--------------------------------------------------------------------------------
MRO Information
Name Janelle A Jaworski M.D.
--------------------------------------------------------------------------------

2
Paycom Payroll, LLC

Analyte Information
Analyte Name Amphetamines
Disposition NEGATIVE
--------------------------------------------------------------------------------
Analyte Information
Analyte Name Cocaine
Disposition NEGATIVE
--------------------------------------------------------------------------------
Analyte Information
Analyte Name Creatinine
Disposition
--------------------------------------------------------------------------------
Analyte Information
Analyte Name Marijuana
Disposition NEGATIVE
--------------------------------------------------------------------------------
Analyte Information
Analyte Name Nitrites
Disposition
--------------------------------------------------------------------------------
Analyte Information
Analyte Name Opiates
Disposition NEGATIVE
--------------------------------------------------------------------------------
Analyte Information
Analyte Name PH
Disposition
--------------------------------------------------------------------------------
Analyte Information
Analyte Name Phencyclidine (PCP)
Disposition NEGATIVE
--------------------------------------------------------------------------------
Analyte Information
Analyte Name Remark
Disposition
--------------------------------------------------------------------------------
Analyte Information
Analyte Name Specific Gravity
Disposition
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Test Type E2AUDI3f9AUDIOGRAM ONLY
Test Package 5UAUDNPHY
Donor Name EVENS MONARGENT
SSN XXX-XX-6796
Other ID 22966712
Reason For Test PRE-EMPLOYMENT
Collection Date 2024-07-05
Specimen Id 2024070316772
Lab Name i3screen
Location Code 647762
Reference ID 2024070316772
Combined Result NOT REVIEWED
--------------------------------------------------------------------------------
MRO Information
Name Janelle A Jaworski M.D.
--------------------------------------------------------------------------------
Analyte Information

3
Paycom Payroll, LLC

Analyte Name
Disposition
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Test Type E2PH1I3f9PHYNONDOT
Test Package 5UAUDNPHY
Donor Name EVENS MONARGENT
SSN XXX-XX-6796
Other ID 22966712
Reason For Test PRE-EMPLOYMENT
Collection Date 2024-07-05
Specimen Id 2024070316773
Lab Name i3screen
Location Code 647762
Reference ID 2024070316773
Combined Result NOT REVIEWED
--------------------------------------------------------------------------------
MRO Information
Name Janelle A Jaworski M.D.
--------------------------------------------------------------------------------
Analyte Information
Analyte Name PHYSICAL EXAM
Disposition

4
 Para información en español, visite www.consumerfinance.gov/learnmore o escribe a la
Consumer Financial Protection Bureau, 1700 G Street NW, Washington, DC 20552.

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 NW, 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

1
 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 from the lists these offers are based on. You may opt out with the
nationwide credit bureaus at 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

2
 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:

3
 TYPE OF BUSINESS: CONTACT:
1.a. Banks, savings associations, and credit unions with a. Consumer Financial Protection Bureau
total assets of over $10 billion and their affiliates 1700 G Street NW
Washington, DC 20552

b. Such affiliates that are not banks, savings b. Federal Trade Commission
associations, or credit unions also should list, in addition Consumer Response Center
to the CFPB: 600 Pennsylvania Avenue NW
Washington, DC 20580
(877) 382-4357
2. To the extent not included in item 1 above: a. Office of the Comptroller of the Currency
a. National banks, federal savings associations, and Customer Assistance Group
federal branches and federal agencies of foreign banks P.O. Box 53570
Houston, TX 77052

b. State member banks, branches and agencies of b. Federal Reserve Consumer Help Center
foreign banks (other than federal branches, federal P.O. Box 1200
agencies, and Insured State Branches of Foreign Banks), Minneapolis, MN 55480
commercial lending companies owned or controlled by
foreign banks, and organizations operating under section c. Division of Depositor and Consumer Protection
25 or 25A of the Federal Reserve Act. National Center for Consumer and Depositor Assistance
Federal Deposit Insurance Corporation
c. Nonmember Insured Banks, Insured State Branches of 1100 Walnut Street, Box #11
Foreign Banks, and insured state savings associations Kansas City, MO 64106

d. Federal Credit Unions d. National Credit Union Administration

Office of Consumer Financial Protection
1775 Duke Street
Alexandria, VA 22314
3. Air carriers Assistant General Counsel for Office of Aviation Consumer Protection
Department of Transportation
1200 New Jersey Avenue SE
Washington, DC 20590
4. Creditors Subject to the Surface Transportation Board Office of Public Assistance, Governmental Affairs, and Compliance
Surface Transportation Board
395 E Street SW
Washington, DC 20423
5. Creditors Subject to the Packers and Stockyards Act, Nearest Packers and Stockyards Division Regional Office
1921
6. Small Business Investment Companies Associate Administrator, Office of Capital Access
United States Small Business Administration
409 Third Street SW, Suite 8200
Washington, DC 20416
7. Brokers and Dealers Securities and Exchange Commission
100 F Street NE
Washington, DC 20549
8. Institutions that are members of the Farm Credit Farm Credit Administration
System 1501 Farm Credit Drive
McLean, VA 22102-5090
9. Retailers, Finance Companies, and All Other Federal Trade Commission
Creditors Not Listed Above Consumer Response Center
600 Pennsylvania Avenue NW
Washington, DC 20580
(877) 382-4357

4
DONOR PASS
Your order / registration will expire on July 18, 2024, at 11:59

Participant Name: EVENS MONARGENT ID: *****6796

Test Reason: PRE-EMPLOYMENT

Service Provider:
CONCENTRA - LAWRENCEVILLE, GA Sun Mon Tue Wed Thu Fri Sat
755 Lawrenceville Suwanee Rd Open 9:00 AM 7:00 AM 7:00 AM 7:30 AM 7:00 AM 7:00 AM 9:00 AM
STE 1600
Lawrenceville, GA 30043 Close 3:00 PM 12:00 AM 12:00 AM 12:00 AM 12:00 AM 12:00 AM 3:00 PM
PH: 770-995-1500 Lunch Open Closed Closed Closed Closed Closed Open
FX: 770-995-1729

Test/Service: PHYSICAL NONDOT

Account: NON-ELECTRONIC ORDER
Order 2024070316773 Panel Code: PHYNONDOT PLEASE USE YOUR PAPER FORM
Lab Name: i3screen

Test/Service: PHYSICAL NONDOT

Account: NON-ELECTRONIC ORDER
Order 2024070316772 Panel Code: AUDIOGRAM ONLY PLEASE USE YOUR PAPER FORM
Lab Name: i3screen

Test/Service: URINE NONDOT

Account: 11754491
Order Q12626939 Panel Code: 28844N
Lab Name: Quest Diagnostics

! Participant Instructions
- Take the page with you to the specimen Service Provider listed above along with a government issued photo ID.
- Call the Service Provider to confirm operational hours.
- Arrive ONE HOUR before closing time to ensure testing can be completed.

Client/Employer Information: MRO Information:

SCHUTZ CONTAINER SYSTEMS INC Janelle A Jaworski M.D.
200 Aspen Hill Road 9501 Northfield Blvd.
Somerville, NJ 08876 Denver, CO 80238
Phone: 908-526-6161 Phone: 877-585-7366
Fax: 855-253-5666

ATTENTION CLINIC PERSONNEL:

Please perform the following tests for this participant:
****5 PANEL URINE + NON DOT PHYSICAL + AUDIOGRAM ****
Barcode will not be present for OCC HEALTH SERVICES. Please use site's forms for ANY OCC HEALTH SERVICES Test.
Immediately after completion of service fax forms to i3screen at 855-253-5666 or email to [email protected].
Please fax invoice to i3screen 855-211-3730 or email to [email protected]

855-241-2455

Can’t print this page? Write down the Order Number(s) and bring it with you to your selected Service

Case #2024070316771 - SCHUTZ CONTAINER SYSTEMS INC - EVENS MONARGENT Page 1/1
 Test Results

Date Results Transmitted: 2024-07-09 4:31 PM Reason for Test: PRE-EMPLOYMENT

Transmitted By: JAJ Date Specimen Collected: 2024-07-05
Participant/Donor: EVENS MONARGENT
Laboratory: Quest Diagnostics
SSN/EID: *****6796 Collection Site: CONCENTRA -
CCF/Specimen ID: CC15813445 Collection Site Phone: 7709951500
Specimen Type: URINE Program: NONDOT
Company: SCHUTZ CONTAINER SYSTEMS INC
Location: SCHUTZ CONTAINER SYSTEMS INC Date MRO Received CCF Copy 2: 2024-07-09
Lab Account Number: 11754491 Date Test Verified by MRO: 2024-07-09

Test Results
Panel - 5 PANEL URINE + 6AM 28844N
Drug Results Screen Confirm
Amphetamines NEGATIVE 1000 500
Cocaine NEGATIVE 300 150
Marijuana NEGATIVE 50 15
Opiates NEGATIVE 2000 2000
Phencyclidine (PCP) NEGATIVE 25 25

MY DETERMINATION/VERIFICATION IS: NEGATIVE-DILUTE

Conditions/Comments
DILUTE SPECIMEN

Certified Medical Review Officer

Janelle A Jaworski M.D.

The information contained in this message is CONFIDENTIAL and is for the intended addressee only. Any unauthorized use, dissemination of the information, or copying of this message is
prohibited. If you believe you have received the message in error, please contact our Client Services Department at and delete the message without copying or disclosing it.

9501 NORTHFIELD BLVD, DENVER, CO 80238 | Phone: 877-585-7366 | Fax: 855-253-5666

Page 1 of 1 Case Number 2024070316771

DONOR PASS
Your order / registration will expire on July 18, 2024, at 11:59

Participant Name: EVENS MONARGENT ID: *****6796

Test Reason: PRE-EMPLOYMENT

Service Provider:
CONCENTRA - LAWRENCEVILLE, GA Sun Mon Tue Wed Thu Fri Sat
755 Lawrenceville Suwanee Rd Open 9:00 AM 7:00 AM 7:00 AM 7:30 AM 7:00 AM 7:00 AM 9:00 AM
STE 1600
Lawrenceville, GA 30043 Close 3:00 PM 12:00 AM 12:00 AM 12:00 AM 12:00 AM 12:00 AM 3:00 PM
PH: 770-995-1500 Lunch Open Closed Closed Closed Closed Closed Open
FX: 770-995-1729

Test/Service: PHYSICAL NONDOT

Account: NON-ELECTRONIC ORDER
Order 2024070316773 Panel Code: PHYNONDOT PLEASE USE YOUR PAPER FORM
Lab Name: i3screen

Test/Service: PHYSICAL NONDOT

Account: NON-ELECTRONIC ORDER
Order 2024070316772 Panel Code: AUDIOGRAM ONLY PLEASE USE YOUR PAPER FORM
Lab Name: i3screen

Test/Service: URINE NONDOT

Account: 11754491
Order Q12626939 Panel Code: 28844N
Lab Name: Quest Diagnostics

! Participant Instructions
- Take the page with you to the specimen Service Provider listed above along with a government issued photo ID.
- Call the Service Provider to confirm operational hours.
- Arrive ONE HOUR before closing time to ensure testing can be completed.

Client/Employer Information: MRO Information:

SCHUTZ CONTAINER SYSTEMS INC Janelle A Jaworski M.D.
200 Aspen Hill Road 9501 Northfield Blvd.
Somerville, NJ 08876 Denver, CO 80238
Phone: 908-526-6161 Phone: 877-585-7366
Fax: 855-253-5666

ATTENTION CLINIC PERSONNEL:

Please perform the following tests for this participant:
****5 PANEL URINE + NON DOT PHYSICAL + AUDIOGRAM ****
Barcode will not be present for OCC HEALTH SERVICES. Please use site's forms for ANY OCC HEALTH SERVICES Test.
Immediately after completion of service fax forms to i3screen at 855-253-5666 or email to [email protected].
Please fax invoice to i3screen 855-211-3730 or email to [email protected]

855-241-2455

Can’t print this page? Write down the Order Number(s) and bring it with you to your selected Service

Case #2024070316771 - SCHUTZ CONTAINER SYSTEMS INC - EVENS MONARGENT Page 1/1
 Test Results

Date Results Transmitted: 2024-07-11 11:09 AM Reason for Test: PRE-EMPLOYMENT

Transmitted By: MR Date Specimen Collected: 2024-07-05
Participant/Donor: EVENS MONARGENT
Laboratory: i3screen
SSN/EID: *****6796 Collection Site: CONCENTRA -
CCF/Specimen ID: 2024070316772 Collection Site Phone: 7709951500
Specimen Type: PHYSICAL Program: NONDOT
Company: SCHUTZ CONTAINER SYSTEMS INC
Location: SCHUTZ CONTAINER SYSTEMS INC Date MRO Received CCF Copy 2:
Lab Account Number: Date Test Verified by MRO: 2024-07-11

Test Results

MY DETERMINATION/VERIFICATION IS: NOT REVIEWED

Certified Medical Review Officer

Janelle A Jaworski M.D.

The information contained in this message is CONFIDENTIAL and is for the intended addressee only. Any unauthorized use, dissemination of the information, or copying of this message is
prohibited. If you believe you have received the message in error, please contact our Client Services Department at and delete the message without copying or disclosing it.

9501 NORTHFIELD BLVD, DENVER, CO 80238 | Phone: 877-585-7366 | Fax: 855-253-5666

Page 1 of 1 Case Number 2024070316772

DONOR PASS
Your order / registration will expire on July 18, 2024, at 11:59

Participant Name: EVENS MONARGENT ID: *****6796

Test Reason: PRE-EMPLOYMENT

Service Provider:
CONCENTRA - LAWRENCEVILLE, GA Sun Mon Tue Wed Thu Fri Sat
755 Lawrenceville Suwanee Rd Open 9:00 AM 7:00 AM 7:00 AM 7:30 AM 7:00 AM 7:00 AM 9:00 AM
STE 1600
Lawrenceville, GA 30043 Close 3:00 PM 12:00 AM 12:00 AM 12:00 AM 12:00 AM 12:00 AM 3:00 PM
PH: 770-995-1500 Lunch Open Closed Closed Closed Closed Closed Open
FX: 770-995-1729

Test/Service: PHYSICAL NONDOT

Account: NON-ELECTRONIC ORDER
Order 2024070316773 Panel Code: PHYNONDOT PLEASE USE YOUR PAPER FORM
Lab Name: i3screen

Test/Service: PHYSICAL NONDOT

Account: NON-ELECTRONIC ORDER
Order 2024070316772 Panel Code: AUDIOGRAM ONLY PLEASE USE YOUR PAPER FORM
Lab Name: i3screen

Test/Service: URINE NONDOT

Account: 11754491
Order Q12626939 Panel Code: 28844N
Lab Name: Quest Diagnostics

! Participant Instructions
- Take the page with you to the specimen Service Provider listed above along with a government issued photo ID.
- Call the Service Provider to confirm operational hours.
- Arrive ONE HOUR before closing time to ensure testing can be completed.

Client/Employer Information: MRO Information:

SCHUTZ CONTAINER SYSTEMS INC Janelle A Jaworski M.D.
200 Aspen Hill Road 9501 Northfield Blvd.
Somerville, NJ 08876 Denver, CO 80238
Phone: 908-526-6161 Phone: 877-585-7366
Fax: 855-253-5666

ATTENTION CLINIC PERSONNEL:

Please perform the following tests for this participant:
****5 PANEL URINE + NON DOT PHYSICAL + AUDIOGRAM ****
Barcode will not be present for OCC HEALTH SERVICES. Please use site's forms for ANY OCC HEALTH SERVICES Test.
Immediately after completion of service fax forms to i3screen at 855-253-5666 or email to [email protected].
Please fax invoice to i3screen 855-211-3730 or email to [email protected]

855-241-2455

Can’t print this page? Write down the Order Number(s) and bring it with you to your selected Service

Case #2024070316771 - SCHUTZ CONTAINER SYSTEMS INC - EVENS MONARGENT Page 1/1
 Test Results

Date Results Transmitted: 2024-07-11 11:07 AM Reason for Test: PRE-EMPLOYMENT

Transmitted By: MR Date Specimen Collected: 2024-07-05
Participant/Donor: EVENS MONARGENT
Laboratory: i3screen
SSN/EID: *****6796 Collection Site: CONCENTRA -
CCF/Specimen ID: 2024070316773 Collection Site Phone: 7709951500
Specimen Type: PHYSICAL Program: NONDOT
Company: SCHUTZ CONTAINER SYSTEMS INC
Location: SCHUTZ CONTAINER SYSTEMS INC Date MRO Received CCF Copy 2:
Lab Account Number: Date Test Verified by MRO: 2024-07-11

Test Results
Panel - PHYSICAL EXAM PHYNONDOT
Drug Results Screen Confirm
PHYSICAL EXAM

MY DETERMINATION/VERIFICATION IS: NOT REVIEWED

Certified Medical Review Officer

Janelle A Jaworski M.D.

The information contained in this message is CONFIDENTIAL and is for the intended addressee only. Any unauthorized use, dissemination of the information, or copying of this message is
prohibited. If you believe you have received the message in error, please contact our Client Services Department at and delete the message without copying or disclosing it.

9501 NORTHFIELD BLVD, DENVER, CO 80238 | Phone: 877-585-7366 | Fax: 855-253-5666

Page 1 of 1 Case Number 2024070316773

 DISCLOSURE REGARDING
BACKGROUND INVESTIGATION ON YOU

_______________
SCHUTZ CONTAINER SYSTEMS INC
( the Company ) may obtain consumer reports
about you from a consumer reporting agency for employment purposes. A
consumer report is a background screening report that may contain
information regarding your criminal history, sex offender registry status,
credit history, employment history, education history, driving history,
professional licenses, and other information about you. It may bear upon
your character, general reputation, personal characteristics, and/or mode of
living.

End of Document

Background Check Disclosure

 SCHUTZ CONTAINER SYSTEMS INC ( the Company ) may also request an
investigative consumer report on you from a consumer reporting agency.

An investigative consumer report is a background screening report generated

through personal interviews with sources such as your neighbors, friends, or
associates.

The consumer reporting agency that may prepare an investigative consumer

report on you for the Company is Paycom, 7501 W. Memorial Rd, Oklahoma
City, OK 73142, 833-927-1465. The information contained in an investigative
consumer report may bear upon your character, general reputation, personal
characteristics, and/or mode of living.

Please be advised that the nature and scope of the most common form of
investigative consumer report that may be ordered by the Company is an
investigation into your employment history. During such an investigation,
Paycom may ask questions about your employment history to certain
knowledgeable individuals and provide response information to the Company.

Note: You have the right to request additional information regarding the
nature and scope of any investigative consumer report ordered by the
Company on you. You may do so by contacting the Company.

End of Document

Additional Notice Investigative Reports

 Para información en español, visite www.consumerfinance.gov/learnmore o escribe a la
Consumer Financial Protection Bureau, 1700 G Street NW, Washington, DC 20552.

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 NW, 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

your Social Security number. In many cases, the disclosure will be free. You are entitled
to a free file disclosure if:

a person has taken adverse action against you because of information in your
credit report;
you are the victim of identity theft and place a fraud alert in your file;
your file contains inaccurate information as a result of fraud;
you are on public assistance;
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

FCRA Summary of Rights

 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.

information in your credit report.

insurance must include a toll-free phone number you can call if you choose to remove
your name and address from the lists these offers are based on. You may opt out with the
nationwide credit bureaus at 1-888-567-8688.

The following FCRA right applies with respect to nationwide consumer reporting
agencies

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

FCRA Summary of Rights

 credit file, a busines
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:

FCRA Summary of Rights

 TYPE OF BUSINESS: CONTACT:
1.a. Banks, savings associations, and credit unions with a. Consumer Financial Protection Bureau
total assets of over $10 billion and their affiliates 1700 G Street NW
Washington, DC 20552

b. Such affiliates that are not banks, savings b. Federal Trade Commission
associations, or credit unions also should list, in addition Consumer Response Center
to the CFPB: 600 Pennsylvania Avenue NW
Washington, DC 20580
(877) 382-4357
2. To the extent not included in item 1 above: a. Office of the Comptroller of the Currency
a. National banks, federal savings associations, and Customer Assistance Group
federal branches and federal agencies of foreign banks P.O. Box 53570
Houston, TX 77052

b. State member banks, branches and agencies of b. Federal Reserve Consumer Help Center
foreign banks (other than federal branches, federal P.O. Box 1200
agencies, and Insured State Branches of Foreign Banks), Minneapolis, MN 55480
commercial lending companies owned or controlled by
foreign banks, and organizations operating under section c. Division of Depositor and Consumer Protection
25 or 25A of the Federal Reserve Act. National Center for Consumer and Depositor Assistance
Federal Deposit Insurance Corporation
c. Nonmember Insured Banks, Insured State Branches of 1100 Walnut Street, Box #11
Foreign Banks, and insured state savings associations Kansas City, MO 64106

d. Federal Credit Unions d. National Credit Union Administration

Office of Consumer Financial Protection
1775 Duke Street
Alexandria, VA 22314
3. Air carriers Assistant General Counsel for Office of Aviation Protection
Department of Transportation
1200 New Jersey Avenue SE
Washington, DC 20590
4. Creditors Subject to the Surface Transportation Board Office of Public Assistance, Governmental Affairs, and Compliance
Surface Transportation Board
395 E Street SW
Washington, DC 20423
5. Creditors Subject to the Packers and Stockyards Act, Nearest Packers and Stockyards Division Regional Office
1921
6. Small Business Investment Companies Associate Administrator, Office of Capital Access
United States Small Business Administration
409 Third Street SW, Suite 8200
Washington, DC 20416
7. Brokers and Dealers Securities and Exchange Commission
100 F Street NE
Washington, DC 20549
8. Institutions that are members of the Farm Credit Farm Credit Administration
System 1501 Farm Credit Drive
McLean, VA 22102-5090
9. Retailers, Finance Companies, and All Other Federal Trade Commission
Creditors Not Listed Above Consumer Response Center
600 Pennsylvania Avenue NW
Washington, DC 20580
(877) 382-4357

End of Document

FCRA Summary of Rights

 AUTHORIZATION REGARDING BACKGROUND INVESTIGATION

By signing below, I acknowledge receipt of the following separate documents (and certify that
I have read and understood them):
DISCLOSURE REGARDING BACKGROUND INVESTIGATION ON YOU;
A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT;
ADDITIONAL NOTICE REGARDING INVESTIGATIVE CONSUMER REPORTS ON
YOU;
ADDITIONAL STATE LAW NOTICES.

By signing below, I also authorize __________________ to obtain consumer reports and

SCHUTZ CONTAINER SYSTEMS INC

investigative consumer reports about me for employment purposes at any time during the
hiring process and throughout my employment, if applicable.

ee_AA83668591c911253

Signature: Date: 07/03/2024

Printed
EVENS MONARGENT
Name:________________________________________________________________________

End of Document

Background Investigation Authorization