DISCLOSURE STATEMENT AND AUTHORIZATION UNDER

THE FAIR CREDIT REPORTING ACT

By this document, Oppenheimer & Co. Inc. (“Oppenheimer”) discloses to you that a consumer report
regarding your credit history, credit worthiness, credit standing, and/or credit capacity may be obtained
from a consumer reporting agency for employment purposes and/or as part of Oppenheimer’s
consideration of your application. A consumer report concerning your credit history, credit worthiness,
credit standing and/or credit capacity may be procured as part of a pre-employment background
investigation and at any time during your employment with Oppenheimer. Prior to requesting such a
consumer report, Oppenheimer asks you read this form and sign the below consent.

Oppenheimer will only request information regarding your credit history, credit worthiness, credit
standing, and/or credit capacity as permitted by law. Oppenheimer is subject to compliance oversight in
accordance with the provisions of 6801 to 6809, inclusive, of Title 15 of the United States Code and state
and federal statutes or regulations implementing those sections.

If a consumer report concerning your credit history, credit worthiness, credit standing and/or credit
capacity is requested, you will be provided with the name and address of the consumer reporting agency
furnishing the report. Oppenheimer will provide you with a copy of your consumer report at no cost upon
request. As required by applicable law, should Oppenheimer rely upon a consumer report for an adverse
action, before taking that action you will be provided with a copy of the consumer report and a summary
of your rights.

If you would like to request a copy of any consumer credit report, if one is obtained, please initial here
______.

I, _______________________, acknowledge that I have read and understand the above disclosure and
hereby consent to and authorize Oppenheimer & Co. Inc. to procure a consumer report concerning my
credit history, credit worthiness, credit standing, and/or credit capacity. I understand that Oppenheimer
may obtain a consumer report concerning my credit history, credit worthiness, and/or credit standing from
a third party consumer reporting agency and expressly authorize it to do so. I understand that if I am
hired, or if I am already employed, this authorization shall remain on file and shall serve as a continuing
authorization for Oppenheimer to procure a consumer report concerning my credit history, credit
worthiness, and/or credit standing for employment purposes at any time during my employment with
Oppenheimer, to the maximum extent permissible by law. This authorization shall expire upon
termination of my employment with Oppenheimer.

_____________________ __________________________
Signature Date

Full Name:
Address:
Social Security No. :
Date of Birth:
Notice to Applicants or Employees who are California residents:

We use the following Credit Reporting Agency to obtain consumer credit reports for California
applicants/employees:

ADP
c/o ADP Screening and Selection Services
301 Remington Street
Fort Collins, CO 80524
1 (888) 606-7868
NOTICE REGARDING CREDIT CHECKS PURSUANT TO CALIFORNIA LAW

Pursuant to Section 1024.5 of the California Labor Code, Oppenheimer informs you that it may obtain a
credit report about you from [name of CRA], because you are seeking to work or currently work in the
following position:

[ ] A position that involves regular access, for any purpose other than the routine solicitation and
processing of credit card applications in a retail establishment, to all of the following types of information
of any one person:
(A) Bank or credit card account information.
(B) Social security number.
(C) Date of birth.

[ ] A position that involves regular access to cash totaling ten thousand dollars ($10,000) or more of
the employer, a customer, or client, during the workday.

By signing below, I acknowledge receipt of this NOTICE REGARDING CREDIT CHECKS

PURSUANT TO CALIFORNIA LAW.

Signature of Applicant ______ Printed Name _______________________

Date: