Step 4: Background/TB Check

We'll need to run a background check before you can work with us.

Step 4:
BACKGROUND, REFERENCES & TB CHECK

* Indicates required field

Name *

First

Last

Date of Birth

Month *

Day *

Year *

Social Security Number *

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Driver's License *

License State *

Driver's License Expiration Date

Month *

Day *

Year *

You must be 21 or older to drive and work with Clients at Le Blanc Consulting. Furthermore, you MUST provide your current automobile insurance, car registration and keep this information current at your own will in our file with each renewal.

Upload Drivers License File *

Max file size: 20MB

Upload Auto Insurance File *

Max file size: 20MB

Once you have cleared the Initial Background check the position you have applied for may require a drug screen test and employment physical. The form can be downloaded below. To make employment faster please provide this information before your orientation.

Name and Address of REFERENCE 1 *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Name and Address of REFERENCE 2 *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Name and Address of REFERENCE 3 *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Background Acknowledgement and Understanding
LeBlanc Consulting Conducts background checks on employment candidates and before proceeding further in the hiring process.
All positions require the processing of fingerprints through the Department of Justice (DOJ) criminal index systems, Federal Bureau of Investigation (FBI), and the Child Abuse Central Index (CACI). You may obtain your DOJ criminal history record by contacting the DOJ at (916) 227-3849. Based on your Position the following websites may be checked as a part of your background check.

SAM-System for Award Management

OIG Exclusion List-Office of Inspector General

Medi-Cal Suspended & Ineligible List

California Licensing Agency(Licenses & Registrants, Medical Doctors & Nurses)

National Practitioners DataBank & Health Care Integrity & Protection

Megans List

Department of Consumer Affairs

I read the Background Acknowledgement and Understanding *

Yes

Background Acknowledgement and Understanding * *

I agree

Back ground report. (Fee's may apply) *

I request a copy of my background report

Declaration Regarding Arrest and Criminal Conviction
Depending on the nature of the work and the work locations, state or federal law may prohibit people with certain convictions from working in some positions. However, it may not rule out employment with LeBlanc Consulting in other positions.

A conviction includes a plea, verdict or other finding of guilt by a court, including a military court, even if no sentencing is imposed an. An arrest or conviction history does not automatically preclude employment. Whether an arrest of conviction will prevent employment in specific job depends on the type of arrest or conviction and the job for which you have applied. d

In order to determine weather you qualify for those position(s) under the state and federal law for which you have applied. Please answer the following questions.

Have you ever been convicted of a crime? *

Yes No, not even in another country Yes, but in another country

Violation, Date and Place of Arrest (if none, type N/A) *

Penalty (Fines, sentences, dates or probation) (If none, type N/A) *

Have you been arrested and are currently out on bail or out on your own recognizance pending a trail? *

Yes No Yes, but in another country

Name under which you were arrested or convicted? (If none, type N/A) *

I read the Declaration Regarding Arrest and Criminal Conviction *

Yes

Declaration Regarding Arrest and Criminal Conviction *

I agree

Declaration Regarding Suspension or Debarment
Under congressional mandate, the federal government established a program to exclude individual and entities, including employees of entities, known as ineligible Persons, from participating in covered transactions by any federal department or agency.

An ineligible person is an individual or entities who: (a) is currently excluded, debarred, suspended, or otherwise ineligible to participate in the Federal Health Care Programs, including Medicare, and Medi-Cade, Federal Assistance Programs; orin Federal procurement or non procurement programs; or (b) has been convinced of a criminal offense that falls within . ambit of 42 U.S.c. S 1320a-7 (a), but has not yet been excluded, debarred or suspended or otherwise declared ineligible.

The undersigned employee or applicant hereby attests that he/she is not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in any State or Federal program or agency. Including but not limited to, the system for Award Management, Office of Inspector General, California Department of Social Services, Department of Disabled Services, or California Medic-cal Program.

Furthermore, employee shall immediately notify his/her supervisor of any change in status of the representations set forth in this section.

I read the Declaration Regarding Suspension or Debarmet *

Yes

Declaration Regarding Suspension or Debarment *

I agree

Affirmation of Understanding and Authorization for Release of Information
I certify that the information contained in this form is true and correct to the best of my knowledge. I understand that any false, misleading or incomplete statement, regardless of when it is discovered my result in my disqualification or dismissal from employment with LeBlanc Consulting. I understand that any omission or misitrepesnation of material fact in the application or other form I filled out for employment may result in denial of, or separation from, employment with LeBLanc Consulting. I hereby authorize LeBlanc Consulting, herinafter referred to as "The Company," to thoroughly investigate my background as deemed necessary. I authorize a LeBLanc Consulting to obtain any information related to my references, work record, education, pay rates, back ground, and other matters related to my suitability for employment and further, authorize the references I have listed to disclose to the Company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosures. This information may include, but is not limited to achievement, performance, and disciplinary information. I direct prior and current employers to release such work related information up request of LeBlanc Consulting Staff. In addition, I hearby release the Company, my former employers and any individual, including but not limited to the records custodian at LeBlanc 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 or that may result to me as a result of complying with the terms of this authorization. .

I read the Affirmation of Understanding and Authorization for Release of Information *

Yes

Affirmation of Understanding and Authorization for Release *

I agree

Electronic Signature: By typing your name, you indicate you've read the above and agree to authorize a background check following the terms above. *

First

Last

By typing your name, you indicate you've read and agree to authorize a background check following the terms below. BACKGROUND CHECK TERMS Le Blanc Consulting, Inc. the entity that contracts with Consultants who provide educational training, and who provide peer-to-peer transportation requested through the Le Blanc Consulting app, is committed to safety. As part of that commitment, Le Blanc uses a third-party vendor to conduct a criminal background check, motor vehicle record check, and other checks. Please review the below disclosure/authorization and release. DISCLOSURE/AUTHORIZATION AND RELEASE FOR THE PROCUREMENT OF A CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT DISCLOSURE: Le Blanc Consulting, Inc. may now, or at any time while you are an independent consultant and independent transportation provider (“Transportation Provider”) (“Education Consultant”), with an independent contractor relationship (“I/C Relationship”) with Consulting, Inc., verify information within your proposal to enter into or maintain an I/C Relationship, resume or contract by obtaining a consumer report and/or investigative consumer report from a consumer reporting agency. The verification and/or checks may include but are not limited to: driving records, workers compensation records (in compliance with the ADA or other applicable law), credit bureau files, employment references, personal references, any educational and licensing institution records, and any criminal records information pertaining to you which may be in the files of any federal, state or local criminal justice agency in any state. These reports may include information as to your general reputation, character, personal characteristics, or mode of living. You have the right to request, in writing, the nature and scope of any investigative consumer report conducted by Le Blanc Consulting, Inc. on behalf of Le Blanc Consulting, Inc., at: 2415 San Pablo Dam Rd #106-152. San Pablo, CA. 94806• 1510-326-3313• www.LeBlancConsulting.net. A photocopy or telephonic facsimile (fax) or electronic copy of this Disclosure/Authorization and Release shall be valid as the original, and my electronic signature will be binding. I further understand that I may request and obtain a paper copy of this Notice/Authorization and Release by contacting Le Blanc Consulting, Inc. at the above address. The results of this verification process will be used as a factor in determining your eligibility to enter into or maintain an I/C Relationship with Le Blanc Consulting, Inc. All results will be kept CONFIDENTIAL. The information obtained will not be provided to any parties other than to authorized personnel of Le Blanc Consulting, Inc or its corporate affiliates, unless otherwise required by law. According to the Fair Credit Reporting Act, if any adverse decision is made with regard to your eligibility as a Transportation Provider, based entirely or in part on the information contained in a consumer report or investigative consumer report prepared by a consumer reporting agency, you are entitled to receive a copy of this report upon written request, and a disclosure of the nature and scope of the investigative report. AUTHORIZATION: I have carefully read and understand this disclosure and consent form and by my signature consent to the release of consumer or investigative consumer reports, as defined above, in conjunction with my proposal to enter an I/C Relationship. I further understand this consent will apply during the course of my I/C Relationship, should I enter an I/C Relationship with LeBlanc Consulting, Inc, and that such consent will remain in effect until revoked in a written document signed by me. As allowed by law, Le Blanc Consulting, Inc may obtain background investigations from a consumer reporting agency other than Le Blanc Consulting, Inc. In the event that I wish to refuse or revoke my consent at any time, I understand that I may do so. I further understand that any and all information contained in my proposal to enter an I/C Relationship, or otherwise disclosed to this company by me, may be used for the purpose of obtaining the consumer reports or investigative consumer reports requested by Le Blanc Consulting, Inc and confirm that all such information is true and correct. I, the undersigned, do hereby certify that the information provided by me in connection with proposal to enter an I/C Relationship is true and complete to the best of my knowledge. I understand that if I enter an I/C Relationship with Le Blanc Consulting, Inc, any false statements will be considered as a cause for possible termination of the I/C Relationship. By entering my name in the box below and clicking “Submit,” I acknowledge and agree that I am providing my electronic signature, that my electronic signature is binding just like a signature in ink, and that my electronic signature demonstrates my authorization for a consumer report and/or investigative consumer report as described above.

Date *

Submit

Get your Federal Background Check Done
by clicking the links below

1) Download the following forms.
2) Take the form to the UPS store (They have lower rates) and bring your ID
3) Pay for your fingerprints
4) Upload proof of your fingerprint by clicking here

Employee Background Check Form.jpg
File Size:	1198 kb
File Type:	jpg

Download File

Volunteer Background Check Form.jpg
File Size:	1198 kb
File Type:	jpg

Download File

live-scan-employee.docx
File Size:	577 kb
File Type:	docx

Download File

We have a partnership with the
UPS StoreLive Scan office
located at
San Pablo Town Center
2415 San Pablo Dam Rd#106
San Pablo, CA 94806
[email protected]

Get your mandatory TB check
by clicking the link below

community-providers-list.pdf
File Size:	232 kb
File Type:	pdf

Download File

View Larger Map | Get Directions | View Bird's Eye

Continue to Step 4 >> DMV Printout

We Provide Services 24/7
Administrative Office Hours:
Monday - Friday 7:00am-7:00pm
Saturday & Sunday by Appointment Only

We operate on Pacific Standard Time.

Contact us:
Toll FREE: 1(800) 707-1852
North Bay Office: 1(707) 654-8488
North Bay Cell: 1(707) 727-9100
East Bay Office: 1(510) 275-3679
East Bay Cell: 1( 510) 241-9115
South Bay Cell: 1(831) 313-7902
Golden Gate Cell: 1(415) 630-0112
E-mail: [email protected]

Our Locations

Apply For Services Here

Quality Assurance Survey

>>> Please Donate <<<

Copyright © 2011-2025, LeBlanc Consulting,Inc.  All rights reserved worldwide.

Please Note: If you have questions, please feel free to contact us and we would be happy to speak with you. Le Blanc consulting reserves the right to refuse services and admission to our programs. Tours and Open house can be reserved by clicking here The information presented in this website is for informational use only. It is not intended to diagnose or treat any medical condition. Please consult a health practitioner before embarking on any health protocol. Moreover, LeBlanc Consulting is not responsible for any problems, issues, or technical difficulties related to downloading or accessing any information on this website. This web site is designed for your general information only. The information presented on this website should not be construed to be formal Therapeutic Counseling sessions or advice nor the formation of a Therapist/client relationship. Furthermore, the hiring of a Professional is an important decision and should not be based solely upon any form of advertisements. Before you decide to hire, please feel free to review our degrees and certification by contacting us for more information about our qualifications and experience.

Mandated Reporter Notice:  All Instructors,Caregivers and staff affiliated with Le Blanc Consulting are considered Mandated Reporters. California Law, under section WIC 15630(a) of the Welfare & Institution Code provides for mandatory reporting of physical abuse, neglect, self neglect, sexual abuse, mental suffering, financial abuse, isolation, abandonment or abduction of a dependent adult when:1) The victim reports abuse has occurred or has knowledge of abuse. 2) You observe the incident. 3) when an injury or condition reasonably leads one to suspect that abuse has occurred. Any signs of abuse will be reported to Child Protective Services or Adult Protective Services.

Intellectual Property & Copyright Material Warning:  All images are on this website copyright to their respective owners/photographers, no copyright infringement intended. Some of the material and documents available for your view is copyrighted and protected by applicable state and federal copyright laws.  LeBlanc Consulting respects the intellectual property of others, and we ask our users to do the same.You are not authorized and may not reproduce, download, post, modify, distribute, or reproduce in any way copyrighted or other proprietary materials that are stored in this database without obtaining the prior written consent of the copyright owner of such materials. We may, in appropriate circumstances and at our discretion, deny access to a site or service or disable and/or terminate the accounts of any user who is alleged to have infringed the intellectual property or proprietary rights of LeBlanc Consulting or another.

The use, reproduction, downloading, or distribution of copyrighted materials and works may subject you to applicable penalties and damages under state and federal copyright laws.  You are granted public access to such copyrighted works in our database for examination and inspection purposes only. Although every reasonable effort has been made to ensure the accuracy of the public information data and graphic representations, LeBlanc Consulting cannot and shall not be responsible for consequences resulting from any omissions or errors contained herein. LeBlanc Consulting assumes no liability whatsoever associated with the use or misuse of this data.

YOUR CART

Step 4:​BACKGROUND, REFERENCES & TB CHECK

Get your Federal Background Check Doneby clicking the links below

Get your mandatory TB check​ by clicking the link below

Continue to Step 4 >> DMV Printout

Step 4:
BACKGROUND, REFERENCES & TB CHECK

Get your Federal Background Check Done
by clicking the links below

Get your mandatory TB check
by clicking the link below