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c <br />d n� v <br />OF <br />was^.. <br />STATE <br />Legal Disclaimer & Consent. <br />Notice and Consent to Use Personal Information (Civil Code Section 1798 et seq.) <br />By submitting personal information about yourself and your company In order to obtain a License or Registration, you consent to <br />DLSE's use of that personal Information for purposes authorized by Department Of Industrial Relations, which provides for the Issuance <br />of such IIl enses and registration. Note that OLSE's use of such personal information includes the disclosure of information about you <br />and your company to third parties who want to verify your Registration Application. This Notice Is effective January 2012, and subject <br />to revision. <br />SOCIAL SECURITY NUMBER COLLECTION <br />The social security number will be collected pursuant to California Family Code section 17520(d). it Is used In the administration bf <br />registering employers in the Garment Manufacturing & Contractor Industry, and to aid in the collection of monies owed pursuant to a <br />judgment or order for child or family support in a case being enforced under Title iV.A of the Social Security Act: Collection of the'social <br />security number is mandatary. Failure to furnish the social security number may result In DENIAL of an application for issuance or <br />renewal of a registration to engage In the business of Garment Manufacturing & Contractor. <br />INFORMATION PRACTICES ACT NOTICE (California Civil Code Section 1798.17) <br />1. The information an this application is being requested by the Department of Industrial Relations, Division of Labor Standards <br />Enforcement. <br />2. The state official responsible for maintaining this application, and who shall, upon written request, inform you of the location of <br />where this application is maintained and the categories of any persons who use the Information contained herein is: <br />Division of tabor Standards Enforcement <br />Manager, Licensing and Registration Unit <br />1515 Clay Street, Ste. 1902 <br />Oakland, CA 94612 <br />Telephone: (510)•285•3398 <br />3.7he information an this application is collected and maintained pursuant to California Labor Code section 2675, <br />4. With respect to the information requested on this application, all of it Is either mandated by California tabor Code section 2675 or <br />must be ascertained by the Labor Commissioner in order to issue a license, except for the following information, which is provided <br />voluntarily. A) Tide of corporate officers/ LLC members <br />5,if you fall to provide all or any part of the information requested In this application, the Labor Commissioner may deny issuance / <br />renewal of a registration to engage in the business of Garment Manufacturing & Contractor, <br />6. The principal purposes within the Division of Labor Standards Enforcement for which the information no this application will be used <br />are: (1) administration of the registration program for the Garment Manufacturing & Contractor Industry, and (2) enforcement of <br />California labor laws. <br />7. The following are known or foreseeable disclosures of the information contained herein which may be made pursuant to subdivision <br />(e) or (f) of Section 1798.24 of the California Civil Code by the Division of Labor Standards Enforcement, Response to a request under <br />the Caiirornra Mtimn, necurw Act. <br />S. you have the right to access records containing your personal information that are maintained by the Division of Labor Standards <br />Enforcement. To make an appointment to access such records, please contact the Manage(, Licensing and Registration Unit at the <br />address shown In Item 2 above. <br />Legal Disclaimer & Consent <br />Notice and Consent to Use Personal Information (Civil Code Section 1798 et seq.) <br />Registration Services.- page 1 of 7 12/16/2p201ri:pltSra AM <br />