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By submitting personal information about yourself and Your company in order to obtain a License or Registration, you cons amid DLSE's use of that personal information for purposes authorized by Department Of Industrial Relation 5. Which provides for the Issuance of such licenses and registration. Note that DLSE,5 use of such personal Information Includes the disclosure of information about you and your company to third parties who want to verity your Registration Application. This Notice Is effective Pintuoy 2012, and subject to revision. SOCIAL SECURITY NUMBER COLLECTION The social security number will he collected pursuant to California Family Code section 17520(U), it is used in the administration of registering employers in the Garment Manufacturing & Contractor industry, and to aid in the collection of mordini owed pursuant to a judgment or order for child or family support in a case being enforced under Title IV-D of the Social Security AcL Collection of the soclat security number is mandatory. Failure to furnish the social security number may result in DENIAL of an apply:a6cin for issuance or renewal of a registration to engage in the business of Garment Manufacturing & Contractor. INFORMATION PRACTICES ACT NOTICE (California Civil Code Section 1799.17) 1, The Information On this application is being requested by the Department of industrial Relations, DIVIscon of Labor Standards Enforcement. 2, The state official responsible for maintaining this application, and who shall, upon written request, Inform you of the location of where this application is maintained and the categories of any persons who Use the Information contained herein is: Division of Labor Standards Enforcement Manager, Licensing and Registration Unit 1515 Clay Street, Ste. 1902 Oakland, CA 94612 Telephone: (510)-285-3398 3.Theinformailon on mls application is collected and maintained pursuant to California Labor Code section 2675. 4. With respect to the Information requested an this application, all of it is either mandated by California Labor Code section 2675 or mum be ascertained by the Labor Commissioner in order to issue a license, except for the following information, which Is provided voluntarily: A) Title of corporate officers/ LLC members 5, if you fall to provide all or any part of the Information requested in this application, the Labor Cpmrms%'oner may deny issuance renewal of a registration to engage In the business of Garment Manufacturing & Contractor. 6. The principal purposes within the Division of Labor Standards Enforcement for which the information an this application will be used are: (1) administration of the registration program for the Garment Manufacturing rit contractor industry, and (2) enforcement at California labor laws. 7. The following are known or foreseeable disclosures of the Information contained herein which may be made pursuant to subdivision (a) or (f) of Section 1798.24 of the California Civil Code by the Division of Labor Standards Enforcement: Response to a request under the California Public Records Act. a. You have the right to access records containing your personal information that are maintained by the Division of Labor Standards Enforcement. To make an appointment to access such records, please contact the Manager, Licensing and Registration Unit at the address shown In item 2 above. Disclaimer Confirmation I Agree: Yes Enter Your Name: Donald E Seaman Registration Services Page 2 Of 7