CALIFORNIA PRIVACY RIGHTS ACT Your privacy is important to us. CPRA Form 1-A California Resident’s Request to Know, Correct, or Delete Pursuant to the California Privacy Rights Act Type of Request(Required) I would like to know the specific pieces of personal information that Company obtained from me (Right to Specific Pieces) I would like to know how Company handles personal information it collects about me (Right to Know) I would like to delete personal information Company collected from me (Right to Delete) Some of my personal information is incorrect and I would like to get it updated (Right to Correct) Other Description of Request:(Required)Please provide specific details about your request, e.g., “delete all of my personal information” or “please list the categories of sources from which the Company collected my personal information.”Sensitive Personal Information: The Company will not disclose the following personal information in response to requests through this form: Social Security number, driver’s license number or other government-issued identification number, financial account number, any health insurance or medical identification number, biometric information, an account password, or security questions and answers.Contact InformationPlease provide an email address or mailing address that we can use to respond to you regarding your request.Email Please note that you are responsible for providing a secure email address.Mailing Address Street Address Address Line 2 City State ZIP Code Please provide your relationship to Company:(Required) Current employee Former employee Current or former applicant Contract worker Dependent, beneficiary, or spouse of a Company employee You can choose more than one.Identifying InformationName(Required) First Middle Last Date of Birth(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Date of ApplicationMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Employee ID NumberName of Employee First Last PhoneLast 4 of Social Security Number(Required)If you are requesting deletion, correction, or a copy of personal information.I hereby declare under penalty of perjury that I am a California resident pursuant to Cal. Code Regs. Tit. 18, § 17014 and that the identifying information I have provided in this form is my personal information. I also agree that writing my name in the box is my electronic signature. An electronic signature is as legally binding as an ink signature.UploadsDocumentation for Request to Correct Inaccurate Personal Information Drop files here or Select files Max. file size: 300 MB. If you are requesting to correct personal information, we encourage you to provide documentation with this request showing that your proposed correction would correct inaccurate personal information. Providing documentation now may expedite your request because we may request documentation upon reviewing your request. Without documentation, we may not have the necessary evidence that the personal information at issue is inaccurate.Authorized AgentsMax. file size: 300 MB.If you are submitting this request on behalf of a California resident, please complete this form on behalf of the California resident and upload here an electronic copy of a notarized Power of Attorney pursuant to Cal. Prob. §§ 4000-4465 designating you to represent the California resident for purposes of this request. If you do not have such a Power of Attorney, the California resident must complete this form him/her/themself and upload a written statement by the California resident which identifies the California resident by name, designates the authorized agent by name, grants the authorized agent the power to submit this request, provides the agent’s contact information, and is signed by the California resident.CAPTCHA We are looking for hard working, enthusiastic individuals! Apply Here
