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«_- Address City State Zip (_)_ (_)_ Home Phone Business Phone Social Security Number EMPLOYMENT DESIRED Position applying for: Are you applying ...»

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_______ ______________________ _______________________ ________________

Date Last Name First Name Middle ______________________ ____ _____-____ __________________________________________

Address City State Zip (_____)_______________ (_____)_______________ ______-____-______ Home Phone Business Phone Social Security Number



Position applying for:

Are you applying for:

Regular full-time work?

Regular part-time work?

Temporary work, e.g., summer or holiday work?

What days and hours are you available for work?________________________________________

Are you available for work on weekends?

Would you be available to work overtime, if necessary?

If hired, on what date can you start work?

Salary desired: ____________________


Have you ever applied to or worked for Collectors Universe before?


If yes, when?

Are you related to anyone working for Collectors Universe

If yes, state name(s) and department: _______________________________________________________

Are you at least 18 years old? (If under 18, hire is subject to verification that you are of minimum legal age.)……….. Yes No If hired, can you present evidence of your U.S. citizenship or proof of your legal right to work in this country? …….. Yes No Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?

(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions) Have you ever been convicted of a felony?

If yes, state nature of the crime(s), when and where convicted and disposition of the case.



(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.) May we contact your current employer?

–  –  –


Your Position and Duties __________________________________________________________________

Your Position and Duties __________________________________________________________________

Reason for Leaving Note: Attach additional page(s) if necessary.

REFERENCES – Please list business references only.

–  –  –

______ I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further Initials certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

______ I hereby authorize the company to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the Initials company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

______ I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the company.

Initials In addition, I understand that Collectors Universe is an at-will employer, and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company’s designated representative.

______ I understand that if I am hired, my employment will be at-will.

Initials ____________ ____________________________________________________________________

Applicant’s Signature Date

–  –  –

In connection with your application for employment or continued employment, Collectors Universe, Inc. (hereinafter referred to as “The Company”) will conduct an investigation into your background by obtaining Consumer Reports and Investigative Consumer Reports, as outlined below. The Company will procure such reports for employment purposes.


By my signature below, I hereby authorize the Company to obtain a Consumer Report/Investigative Consumer Report in connection with my application for employment and at any time during my employment with the Company. I understand that the nature and scope of such an investigation may include, but is not limited to, obtaining the following information: (1) For the last seven (7) years with respect to any public record of criminal conviction(s), credit bureau reports, motor vehicle records, lawsuits, unsatisfied judgments, accounts placed for collection, paid tax liens and unlawful detainer actions, (2) for the last ten (10) years with respect to bankruptcies, and (3) verification of any information provided to the Company either in connection with my employment or during my employment with the Company, including, but not limited to, employment history and educational history. The aforementioned information may be obtained from various sources, including, but not limited to, public records such as state and federal law enforcement agencies, credit reporting agencies, Department of Motor Vehicle records and criminal and civil courts. Additionally, information may be obtained concerning my character, general reputation, personal characteristics, or mode of living that may be obtained through any means, including, but not limited to, personal interviews with neighbors, associates, employers or with others who I am acquainted with or who may have knowledge concerning my character, general reputation, personal characteristics or mode of living.

I further understand that if the Company considers any information in any Consumer Report(s) obtained on me when making an employment related decision that directly and adversely affects me (such as denial of employment or termination of employment), I will be provided with a copy of the Consumer Report(s) prior to the Company taking any adverse action against me.

A Summary of Your Rights the Fair Credit Reporting Act has been attached to this Disclosure. Additionally, for California employees, a summary of California’s Civil Code governing background checks is attached to this Disclosure. By your signature below, you acknowledge receipt of such provision(s).

 California applicants are entitled to a free copy of any report(s) obtained by the Company from public records, including any consumer credit report. If you would like to receive copies of such reports, please check the attached box.

The Company requests report(s) from the following agencies and/or entities:

SentryLink, LLC, 7500 Greenway Center Drive, Suite 1040, Greenbelt, MD 20770 – 1 (800) 736-8791 California Court Records I understand that I have the right to inspect visually the files concerning me maintained by an investigative consumer reporting agency during normal business hours and upon reasonable notice. The inspection can be done, with proper identification, either in person, by making a written report via certified mail or by telephone.

I hereby release the Company and its agents and all persons, agencies and entities providing information or reports about me from any and all liability arising out of the requests for or release of any of the above mentioned information or reports. A photocopy of this authorization and release shall be considered as effective and valid as the original. This authorization is valid for all federal, state, county and local agencies and authorities.

I have read and understand the above contents, and my signature below indicates my voluntary agreement with the above terms and conditions.

–  –  –

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. 1681-1681u, at the Federal Trade Commission's web site (http://www.ftc.gov). 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 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.

 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

April 22, 2008 - Collectors Universe, Inc. 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:

–  –  –


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