A. PERSONAL INFORMATION
B. PERSONS FOR CHECK
- You may add additional entries for persons as required.
Employees
individual(s) currently employed by your company.- June_Micheal
- Jase_Junius
- Jay_Plague
- Josh_Majiedt
- Gareth_Barr
- Matthew_Armstrong
- Luna_Mcmillan
- Caya_Plague
- Jamie_Jo
- Lynn_Kilgore
- Jayden_Berkowitz
- Athena_Prophetia
- Moshe_Silverstein
- Kitty_Petrova
- Alice_Sirren
- Nina_Varos
- Viktor_Chapel
- Dante_Rocha
- Luis_Rome
- Ruwin_Korbel
- Kinzie_Leblanc
- Inori_Komatsu
- Jackson_Hendrixs
- Harry_Petrova
- Max_Warren
- Scottie_Cross
- Tony_Harper
- Clara_Malone
- Eliza_Sky
- Myles_Hart
- Ava_Valentine
- Jakob_Wheeler
- Maurice_Scanlon
- Maserati_Steven
- John_Bombadil
- Daniel_Carmello
- Naelee_Hart
- Anna_Winchester
- Trevor_Hendrixs
- Conrad_Fredrico
- Rico_Portorico
individual(s) seeking employment with your company.- Fname Lname
- Fname Lname
- Fname Lname
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: Luna McMillan
C2. Date Signed: 22/AUG/2025


