Thurston Springer Pre-Hire Authorization Form

PRE-HIRE BACKGROUND CHECK AUTHORIZATION

DISCLOSURE TO CONSUMER OF INTENT TO OBTAIN A SCREENING REPORT, and

PROOF OF PRODUCTION

Thank you for your interest in becoming a Thurston Springer advisor.

Completing this form will allow Thurston Springer to conduct a background check to identify any potential issues in becoming registered with us. Your electronic signature below authorizes Thurston Springer to view your Form U-4 in CRD and to verify your criminal, credit and other history, as detailed in this form. The examination of your Form U-4 and other materials will be used for pre-employment purposes only.

You present the below answers as true and correct and understand that these responses will be used as the basis of extending an offer to you. You understand that falsely answering any below question is breach of any offer that may be extended to you and will result in your immediate termination and will require immediate repayment of all funds or bonus provided to you.

Please provide your first name *

Please provide your last Name *

Please provide your CRD Number - Please see https://brokercheck.finra.org/ *

FINRA Brokercheck - Opens in new window

What is your personal e-mail address? *

What is your Social Security Number? *

What is your date of birth? Please enter in this format 01-01-1970. * +

Please provide your primary residential address, including street, city, state, and zip code. *

Are you a Broker, Advisor, or Both? *

Broker

Advisor

Both a Broker and an Advisor

Not sales related, or I have not previously worked in a sales role

I am not the subject of any current or ongoing investigation by FINRA, the SEC, or any other regulator. *

True

False

I am not the subject of any current or ongoing complaint. *

True

False

I am not the subject of any current or ongoing arbitration, lawsuit, or other legal proceeding. *

True

False

I am not the subject of any current or ongoing internal review by a prior firm. *

True

False

I do not have any outstanding liens or judgments. *

True

False

In the prior 10 years, I have not filed for bankruptcy or had a compromise with creditors. *

True

False

I am not the subject of any current, recent, or ongoing termination from securities employment for violating any rule or code of conduct. *

True

False

I am not aware of any circumstance that might eventually result in my inability to answer affirmatively any of the above questions. *

True

False

If I have a negative response to one or more of the above questions, I will explain the details of same to the satisfaction of Thurston Springer. *

True

False

I understand that if I become the subject of any of the above prior to becoming registered with Thurston Springer, I will promptly notify Thurston Springer of all relevant details and will furnish Thurston Springer with all relevant, non-privileged, documents. *

True

False

Disclosure to Consumer of Intent to Obtain a Screening Report

In order to comply with FINRA Rule 3110(e) regarding our obligation to verify the accuracy and completeness of information contained in a registration applicant’s form U-4, Thurston, Springer, Miller, Herd & Titak, Inc. intends to employ the services of a screening company to perform the following investigations in connection with employment:

•Social Security Number Validation

•Credit/Financial History

•Terrorist Watch Lists

•Disciplinary Actions from Numerous Financial Regulators

•Criminal Records

•Employment History Verification

The information obtained in the Screening Report will not be used in violation of any federal or state equal opportunity law or regulation.

Before taking any adverse action against an employee based on the Screening Report, you shall be provided with a copy of the Screening Report and a description in writing of the rights of the consumer as prescribed by the Federal Trade Commission (Summary of Consumer Rights).

You hereby authorize the procurement of the Screening Report by Thurston Springer Financial.

By electronically signing below, you authorize Thurston Springer to perform the background checks and verifications detailed above. *

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