A. PERSONAL INFORMATION
B. PERSONS FOR CHECK
- You may add additional entries for persons as required.
Employees
individual(s) currently employed by your company.- Lewis_Langley
Larry_Wrzosek
Naelee_Hart
Neakay_Langley
Gareth_Barr
Tom_Daniels
Markus_Knight
Bongo Mason
Javonte_Simmons
Britt Wrzosek
Maserati Steven
Kim_Taek
Aurora_Hart
Johnny_Stracci
Maurice_Scanlon
Olivia_Devalera
Tony Torres
Cheng_Izumi
Joel_Weatherby
Tony_Harper
Jamie_Jo
Josh_Vaeseri
Kelson Mathers
Jay_Valentino
Meg_Sanchez
Daniel_Nolan
Synn_Jinnal
Angelo Wrzosek
Jimmy Gambino
Charlie_Morgan
Myles Hart
Jack Falkenlove
Scarlett Knight
Frank Xiao
Harry Petrova
Fauna Petrova
Marcus Setzer
John Gradwick
Mavi Shinoda
Jacob Evans
Colton Bryce
Jackson Hendrixs
Kero_Sene
Tim Goodbarz
Max Barr
Dexter Smalls
Flex Barr
James_Eriksen
Dean Ryder
Larry Ultra
Collin Jedarski
Rob Reaper
Adam Evans
Ava Valentine
Trevor Hendrixs
Corey Cougzy
Parosh Cinco
Jayden Berkowitz
Josh Lewsi
Virgil Jefferson
Rava Wayz
Lena Barlow
Jax Zimmerman
Seraphina Rosegem
Frank Gallant
Oliver Crok
Alexander Kazem
Liam Volkov
Patrick Piper
Lina Alvarez
Jayson Powers
Rocky Harrison
Blake Davidson
Jase Junius
Tom Dunkin
Paul River
individual(s) seeking employment with your company.- Fname Lname
- Fname Lname
- Fname Lname
- Lewis_Langley
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: 27/JUL/2025


