A. PERSONAL INFORMATION
B. PERSONS FOR CHECK
- You may add additional entries for persons as required.
Employees
individual(s) currently employed by your company.- John Gradwick
James_Eriksen
Leon Wagner
Kero_Sene
Mavi Shinoda
Jacob Evans
Tim Goodbarz
Colton Bryce
Jackson Hendrixs
Christopher Miles
Max Barr
Dexter Smalls
Flex Barr
Vladimir Bashkimi
Jamie Bellow
Tony Rodriquez
Dean Ryder
Larry Ultra
Collin Jedarski
Rob Reaper
Damian Nolan
Joel Julian
Trevor Hendrixs
Marcus Cole
Corey Cougzy
Parosh Cinco
Lena Barlow
Jax Zimmerman
Marley Bob
Seraphine Rosegem
Paulie Chan
Lewis Clarke
Virgil Jefferson
RAVA Xiao
Tommy Corzetti
Frank Gallant
Jayden Berkowitz
Bob Crispy
Oliver Crok
Filip Lynch
Scheeno Barbados
individual(s) seeking employment with your company. - John Gradwick
C. REQUEST OPTIONS
- Please be mindful of our staff's time and only mark the required checkboxes for the performance of your duties; for example, if no amount of citations can affect employment, do not mark the citation box.
B.1 - Timeframe:
Mark only one box by changing [cb] to [cbc]
- One week
Two weeks
Three weeks
Mark up to three boxes by changing [cb] to [cbc]
- Citations
Misdemeanors
Felonies
- One week
D. ACKNOWLEDGEMENT
- I, the undersigned, affirm under penalty of forgery, that all information provided above is accurate, to the best of my knowledge. I affirm that my employer is aware of me submitting this request, and allows it as per internal guidelines or direct order. I affirm that all of the individuals listed in section B are aware that a background check is being performed on them, and that they have consented to this.
C1. Signature: NaeLee Hart
C2. Date Signed: 07/JUL/2025
