Initial Questions

Before we get started on your pre-employment background investigation, we have a couple of preliminary questions and information that we would like to share with you. Reminder, as these types of background investigations can take some time to complete. Therefore time is of the essence during this process to ensure there are no delays. We appreciate your timely response to all communications during the process and make sure to continuously check your emails and spam folders to ensure you don’t miss any important tasks.

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Target Entry ID

This is the Entry ID from the new entry placed in the Auditor Initial Review form

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Unique ID

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Case Entry ID

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Workflow Parent Entry ID

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Workflow Parent Entry Url

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Investigator Name

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Investigator Email

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Case #

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Purpose

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Expidited Case

Candidate Name(Required)

First Last

Candidate Email address(Required)

Phone

Agency Name(Required)

Position(Required)

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Time is of the essence in this process, therefore your attention to timelines and details are very important. Part of the background investigation includes your ability to read, understand and follow instructions throughout the process. With that said, make sure that you read all correspondences and all attachments in their entirety.

During this background process, check your email no less than once a day to ensure you are not missing any communications. We will periodically send out requests for information via email, and non-responses will delay the process.

Acknowledgment(Required)

Check the box acknowledging the request to check email no less than once a day. Additionally, I acknowledge my failure to respond to text messages, telephone calls, or emails on a timely basis manner can result in my being removed from the process.

City of Residency(Required)

Please enter the city where your current permanent residency address is located.

County of Residency

Please select the county where your current permanent residency address is located.

City of Employer(Required)

Please enter the city where your current employer is located, or last employer if unemployed.

County of Employer

Please select the county where your current employer is located, or last employer if unemployed.

# of Residency (Addresses which you have lived)(Required)

Please enter the total number of locations you resided in the last twelve months (1 year).

# of Employers(Required)

Please enter the total number of employers you have had in the last 36 months (3 years).

Are you currently serving, or have you ever served in any branch of the US Military?(Required)

Yes

Please list each branch of service and the dates you served for each.(Required)

Not including Military Service have you lived outside of the United States in the last 10 years?(Required)

Yes

Please list all the countries and time frames which you lived outside of the United States.(Required)

Driving History: Have any of the following occurred in the timeframe specified? If anything listed has occurred, please mark “yes”?(Required)

Yes

Currently, is your driver’s license suspended or revoked?
In the prior 2 years: Have you had two or more at-fault traffic collisions?
In the prior 2 years: Do you have three or more moving traffic violations?
In the prior 3 years: Any Driving while Under the Influence (DUI)?

Please provide details to include dates and type of events.(Required)

Have any of the following occurred in the timeframe specified? If anything listed has occurred, please mark “yes”? please mark “yes.”?(Required)

Yes

Do you currently have any unresolved court appearances or fines, failures to appear, or failures to pay in any court?
In the prior 3 years: Have you had two or more arrests and/or detention in custody, jail, or held in handcuffs?
In the prior 5 years, have you had three or more failures to appear or failures to pay fines in any court?
In the prior 10 years: Any criminal convictions?

Please provide details to include dates and type of events.(Required)

Have you had 2 or more Terminations for Cause (Fired), Resignations in Lieu of Termination, and/or Rejections During Probation for Cause from any employer within the last two years?(Required)

Yes

Please provide further information to include the employers name, date of seperation, and reason for seperation.(Required)

Are you currently in backgrounds with any other agency?(Required)

Yes

Please provide what agency, when you started, what is your current status, and contact information for your background investigator for each background you are current paraticipating in.(Required)

Have you been in the background process with any other agency in the last three years, either successfully or unsuccessfully?(Required)

Yes

Estimated # of Backgrounds you have been subject to in the last three years (36 months)?(Required)

Please identify each agency, and what were the results of the background.(Required)

Is there anything in your background you are concerned about that may be potentially disqualifying that you would like to discuss now with a background investigator?(Required)

Yes

Please provide details about the area(s) of concern including the type of event, date, location, and your role in the event.(Required)

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Coordinator ID #

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Coordinator Name

First Last

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Coordinator Email