<%@ Page Title="" Language="vb" AutoEventWireup="false" MasterPageFile="~/Driver/application/Application.Master" CodeBehind="CBCRelease.aspx.vb" Inherits="Web.CBCRelease" %>
<%@ MasterType VirtualPath="Application.Master" %>
<%@ Register TagPrefix="ctrl" Namespace="Web" Assembly="Web" %>
<%@ Register Src="~/_include/controls/StatePicker.ascx" TagPrefix="ctrl" TagName="StatePicker" %>
<%@ Register Src="~/_include/controls/Signature.ascx" TagPrefix="ctrl" TagName="Signature" %>
<%@ Register Src="~/_include/controls/SocialBox.ascx" TagPrefix="ctrl" TagName="SocialBox" %>
<asp:Content ID="Content1" ContentPlaceHolderID="phContent" runat="server">

    <h1>Criminal Background Check Release</h1>

    <section id="authorization">
        <h1>Fair Credit Reporting Act Disclosure and Authorization Form</h1>
        <h2>For Employment Purposes</h2>

        <p>Pursuant to the Federal Fair Credit Reporting Act (FCRA), I hereby authorize my prospective or current employer, <span class="autofilled"><%= Master.app.clientName %></span>, Transportation Compliance Services, USA (TCS) a Consumer Reporting Agency (CRA), and their designated agents and representatives to conduct a comprehensive review of my background through a <em>consumer report and/or an investigative consumer report</em> to be generated for employment, promotion, reassignment or retention as an employee. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: verification of Social Security number; current and previous residences; employment history, including all personnel files; education; references; credit history and reports; criminal history, including records from any criminal justice agency in any or all federal, state or county jurisdictions; birth records; motor vehicle records, including traffic citations and registration; and any other public records.</p>

        <p>I, <span class="autofilled"><%= Master.app.applicantName %></span>, authorize the complete release of these records or data pertaining to me that an individual, company, firm, corporation or public agency may have. I hereby authorize and request any present or former employer, school, police department, financial institution or other persons having personal knowledge of me to furnish my prospective or current employer <span class="autofilled"><%= Master.app.clientName %></span>, Transportation Compliance Services, USA (TCS), or their designated agents and representatives with any and all information in their possession regarding me in connection with an application of employment. I am authorizing that a photocopy of this authorization be accepted with the same authority as the original.</p>

        <p>I understand that, pursuant to the federal Fair Credit Reporting Act (FCRA), if any adverse action is to be taken based upon the consumer report, a copy of the report and a summary of the consumer's rights will be provided to me.</p>

        <ctrl:Signature ID="sigConsent" runat="server" ContextId="authorization" />

    </section>

    <section id="background">
        <h1>Background Information Form</h1>

        <ul class="formFields"><li class="big">
            <asp:Label runat="server" AssociatedControlID="txtName" Text="Name" />
            <asp:TextBox ID="txtName" runat="server" Enabled="false" />
        </li></ul>

        <ul class="formFields">
        <li>
        <table style="width: 600px;">
            <tr>
                <th>Former Name</th>
                <th>Used Until</th>
                <th style="width: 100px"></th>
            </tr>
            <asp:Repeater ID="rptFormerNames" runat="server">
                <ItemTemplate>
                    <tr>
                        <td>
                            <asp:RequiredFieldValidator runat="server" ControlToValidate="txtName" Text="required" Display="Dynamic" CssClass="required" />
                            <asp:TextBox ID="txtName" runat="server" MaxLength="128" />
                        </td>
                        <td>
                            <asp:RequiredFieldValidator runat="server" ControlToValidate="dtName" Text="required" Display="Dynamic" CssClass="required" />
                            <asp:TextBox ID="dtName" runat="server" TextMode="Date" />
                        </td>
                        <td>
                            <asp:HiddenField ID="hidNameId" runat="server" Value="0" />
                            <asp:LinkButton ID="btnRemoveName" runat="server" CausesValidation="false" OnClick="btnRemoveName_Click" Text="Remove" />
                        </td>
                    </tr>
                </ItemTemplate>
            </asp:Repeater>
            <tr>
                <td colspan="3" style="text-align: center">
                    <asp:LinkButton ID="btnAddName" runat="server" CausesValidation="false" Text="Add Previous Name" />
                </td>
            </tr>
        </table>
        </li>
        </ul>

        <ul class="formFields">
            <li>
                <asp:RequiredFieldValidator runat="server" ControlToValidate="txtSocial" Text="required" Display="Dynamic" CssClass="required" />
                <asp:Label runat="server" AssociatedControlID="txtSocial" Text="Social Security Number" />
                <ctrl:SocialBox ID="txtSocial" runat="server" />
            </li>
            <li>
                <asp:RequiredFieldValidator runat="server" ControlToValidate="dtBirth" Text="required" Display="Dynamic" CssClass="required" />
                <asp:Label runat="server" AssociatedControlID="dtBirth" Text="Date of Birth" />
                <asp:TextBox ID="dtBirth" runat="server" TextMode="Date" />
            </li>
            <li>
                <asp:RequiredFieldValidator runat="server" ControlToValidate="ddlGender" Text="required" Display="Dynamic" CssClass="required" />
                <asp:Label runat="server" AssociatedControlID="ddlGender" Text="Gender" />
                <asp:DropDownList ID="ddlGender" runat="server">
                    <asp:ListItem Text="Male" />
                    <asp:ListItem Text="Female" />
                </asp:DropDownList>
            </li>
            <li class="big">
                <asp:RequiredFieldValidator runat="server" ControlToValidate="txtLicenseNumber" Text="required" Display="Dynamic" CssClass="required" />
                <asp:Label runat="server" AssociatedControlID="txtLicenseNumber" Text="Driver's License Number" />
                <asp:TextBox ID="txtLicenseNumber" runat="server" MaxLength="128" />
            </li>
            <li>
                <asp:RequiredFieldValidator runat="server" ControlToValidate="ddlLicenseState" Text="required" Display="Dynamic" CssClass="required" />
                <asp:Label runat="server" AssociatedControlID="ddlLicenseState" Text="Driver's License State of Issuance" />
                <ctrl:StatePicker ID="ddlLicenseState" runat="server" />
            </li>
        </ul>

        <h3>Address History:</h3>
        <ul class="formFields">
        <li>
        <table>
            <tr>
                <th>Address</th>
                <th>City</th>
                <th>State</th>
                <th>Zip</th>
                <th>Until</th>
                <th></th>
            </tr>
            <asp:Repeater ID="rptAddresses" runat="server">
                <ItemTemplate>
                    <tr>
                        <td class="big">
                            <asp:RequiredFieldValidator runat="server" ControlToValidate="txtAddress" Text="required" Display="Dynamic" CssClass="required" />
                            <asp:TextBox ID="txtAddress" runat="server" MaxLength="128" />
                        </td>
                        <td>
                            <asp:RequiredFieldValidator runat="server" ControlToValidate="txtCity" Text="required" Display="Dynamic" CssClass="required" />
                            <asp:TextBox ID="txtCity" runat="server" MaxLength="50" />
                        </td>
                        <td class="small">
                            <asp:RequiredFieldValidator runat="server" ControlToValidate="ddlState" Text="required" Display="Dynamic" CssClass="required" />
                            <ctrl:StatePicker ID="ddlState" runat="server" />
                        </td>
                        <td class="small">
                            <asp:RequiredFieldValidator runat="server" ControlToValidate="txtZip" Text="required" Display="Dynamic" CssClass="required" />
                            <asp:TextBox ID="txtZip" runat="server" MaxLength="10" />
                        </td>
                        <td class="small">
                            <asp:RequiredFieldValidator ID="valUntil" runat="server" ControlToValidate="dtUntil" Text="required" Display="Dynamic" CssClass="required" />
                            <asp:TextBox ID="dtUntil" runat="server" TextMode="Date" />
                            <asp:Literal ID="txtUntil" runat="server" Text="current" Visible="false" />
                        </td>
                        <td class="small">
                            <asp:HiddenField ID="hidAddressId" runat="server" Value="0" />
                            <asp:LinkButton ID="btnRemoveAddress" runat="server" CausesValidation="false" OnClick="btnRemoveAddress_Click" Text="Remove" />
                        </td>
                    </tr>
                </ItemTemplate>
            </asp:Repeater>
            <tr>
                <td colspan="6" style="text-align: center">
                    <asp:LinkButton ID="btnAddAddress" runat="server" CausesValidation="false" Text="Add Previous Address" />
                </td>
            </tr>
        </table>
        </li>
        </ul>

        <p>By signing below, you are certifying that the above information is true and correct.</p>

        <ctrl:Signature ID="sigBackground" runat="server" ContextId="background" />

    </section>

</asp:Content>
