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Please Complete and FAX to 800-844-2722
Company Information:
Company Name __________________________________________________________________________
Other Trade Names _______________________________________________________________________
Address_______________________________________City________________________State________Zip
Billing Address_________________________________City________________________State________Zip
Contact:____________________________________________ Billing Contact ________________________
Type of Business in the State of__________ Corporation _________Partnership __________Sole Proprietor
Phone____________________________ FAX ____________________________Email__________________
Number of Employees___________________ Approximate Employee Turnover Rate _____%
Employment Screening Services:
We expect to order the following Employment Screening Services:
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Education Confirmation Professional License & Credential Checks Personal and/or Professional References Federal Criminal Records Statewide Criminal Records Index Criminal Records County Criminal Records Driving Records Employment Credit Reports Workers Compensation History Social Security # Validation D.O.T. Screening For Commercial Drivers |
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Ordering/Result Reporting Details
(check all that apply):Ordering EMPLOYMENT SCREENING:
___We will FAX orders
___We will Mail orders
Receiving/Reviewing EMPLOYMENT SCREENING Results:
___Email results to persons indicated above
___FAX results to persons indicated above
** ___CALL before FAXing
___Phone RED FLAG results
___Mail results
Employment Screening Contacts:
Name of person(s) who can Submit EMPLOYMENT SCREENING Orders
Name:___________________________Email:_____________________Phone:________________FAX:________________
Name:___________________________Email:_____________________Phone:________________FAX:________________
Name of person(s) who can Receive EMPLOYMENT SCREENING Results
Name:___________________________Email:_____________________Phone:________________FAX:________________
Name:___________________________Email:_____________________Phone:________________FAX:________________