A. PERSONAL INFORMATION
B. PERSONS FOR CHECK
- You may add additional entries for persons as required.
Employees
individual(s) currently employed by your company.- Jacob Evans
Colton Bryce
Jackson Hendrixs
Kero_Sene
Tim Goodbarz
Christopher Miles
Max Barr
Dexter Smalls
Flex Barr
Vladimir Bashkimi
Jamie Bellow
Tony Torres
Dean Ryder
Larry Ultra
Collin Jedarski
Rob Reaper
Damian Nolan
Trevor Hendrixs
Marcus Cole
Corey Cougzy
Parosh Cinco
Jayden Berkowitz
Filip Lynch
Tyquarious Tinklefoot
Josh Lewsi
Karthik Kayan
Virgil Jefferson
RAVA Xiao
Lena Barlow
Jax Zimmerman
Marley Bob
Seraphine Rosegem
Paulie Chan
Lewis Clarke
Tommy Corzetti
Frank Gallant
Bob Crispy
Oliver Crok
Alexander Kazem
Arian Shams
Patrick Piper
Lina Alvarez
individual(s) seeking employment with your company.- Fname Lname
- Fname Lname
- Fname Lname
- Jacob Evans
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: 13/JUL/2025

