Background Screening Request Form
Requester
Name
Company
Phone Number
Email Address
Reference Name/Number
Applicant to Screen
Name
*First, Last, Middle, Maiden Name
Race
Sex
Birth Date
Social Security No.
Driver's License No.
Driver's Licence State
Current Address
City, State Zip
,
Previous Address
City, State Zip
,
I authorize that I am compliant with the Fair Credit Reporting Act and have obtained a signed release from the applicant authorizing Intelli Investigations, LLC and the above mentioned company to inquire into the background of the above mentioned applicant.
Same Day Request
1 Hour Request ($10.00 Rush Fee Applies)
