- Integrity and Professionalism -







APPLICANT SCREENING REQUEST (secure SSL form)
 Applicant Screening Release Form

Your File Number:

 		 Client / Company Name:
Requestors / Your Name:

 
Your Phone:
 Your Fax:

Your Email Address (required):

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Applicant Type:        

Please select the components for this screening

Criminal - State (use ctrl to select multiple states)
Employment Verification - # of employers to verify
Credit Education Verification
DMV License Behavioral Survey
Social Security Trace Drug Screening
Personal Interview Opinion Survey
Federal District Court Federal Bankruptcy Court
Professional Licensing Civil Record Search
National Sex Offender Search Patriot Act Search (OFAC)

For Credit Profiles, please print the Authorization Form, have applicant sign the authorization and fax to 631-225-1580.
(Authorization Form is in Acrobat PDF format -
if unable to open please visit Adobe Acrobat for free download of Acrobat Reader)

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Applicants Name:

Other Names Used:

Address:

City, State & Zip:

Prior Address:

Prior Address City, State & Zip:

Date of Birth:

Social Security Number:

Phone Number:

Mobile Phone / Pager:

Applicants E-Mail:

Drivers License # and State
 

Criminal Convictions Claimed:

       

Please be sure to fax the applicant application and authorization form
to  (631) 225-1580 after submitting electronic request!