Employment Background Screening Request
Dealership Name:
Dealership Phone Number:
Date:
Name Of Person requesting search:
RISK MANAGEMENT SERVICES
E-Mail Address:
Search Results to be returned VIA FAX to number:
Search Results to be returned VIA E-Mail to:
Employee Search Requested on: (Last Name)
Search Requested on: (First Name)
Search Requested on: (Middle Name)
N/A:
Employee Social Security Num:
Employee Street Address:
MVR ($7.50 plus State fee) search Information:
Drivers license Number:
Drivers License State:
If other than Florida, the County Name Is also Required:
Any Aliases Or Also Known As?
Please note that the person or firm requesting this information is responsible for being sure that any information requested is being requested and used n full compliance with all Federal and State laws concerning such information including but not limited to the Fair Credit Reporting Act, and that you agree to HOLD HARMLESS Dealers Insurance Services from any and all liability arising out of your use of this information. Moreover, we make no claim or warranty as to the accuracy of any information.
ITEMS IN RED ARE REQUIRED
Date Of Birth:
City, State and Zip:
Request State Wide Criminal
($19.50) record check from State of:
Request County Criminal ($19.50)
record check from County of:
If other than Florida, the State Name Is also Required:
For required release and authorization forms: Click Here
Request Workers' Comp claim History check from the State of:
Florida ($5.00) (Varies by State)
Please enter any comments or special instructions in the box below.
Request Social Security Number Trace which provides all names and addresses associated with number for past 7 years ($7.50)
Request Employment verification from:
($12.00 each) Emp. # one
Request Employment verification from: Emp. # two
Request Drug Screening ($32.00)
For previous employment verification requests please give full particulars including names, addresses, phone numbers, dates of employment, position held and contact persons.
OR, ORDER INDIVIDUAL EMPLOYMENT SCREENING ITEMS BELOW.
Request Credit Report ($12.00) (FCRA Compliant)
If ordering package one,
please Specify if you are requesting a State or County Criminal Background Check below
New! To order these reports directly and in real time: Click Here
_________________________________________________________________________________________
None of the information in this web site should be construed as legal or insurance advice.
All forms, policies, terms, information and procedures should be reviewed by your legal
counsel before being used in any way. Copyright © 2004 DIS
If you would like to receive an occasional e-mail of interest to dealership management: Click Here
__________________________________________________________________________________________
