(* Indicates a required field)

*Contact Name: *Email Address: Company Name: Company Address: *City: *State: Zip: *Telephone: Fax:

Are you currently screening your prospective employees?  Yes No
Do you outsource your background investigations or perform them in-house?  Outsource In-House N/A

How many locations does your company have?

How did you hear about our company?  Search Engine Referral HR Organization Other  >> If “other”

Which of our services are you interested in? (check all that apply)

 Employment Screening
 Nuclear Screening
 Tenancy Screening
 Screening Support Services
 Security Consulting

What components of a screening program are you interested in? (check all that apply)

 Civil History
 Credit History
 Criminal History
 Drug and Alcohol Screening
 Education Verification
 Employment Verification
 Employment Verification- Regulated
 Military History
 Motor Vehicle Driving Records
 Professional Licensing
 Professional References
 Sex Offender Registry Searches
 Social Security Number Trace
 Workers’ Compensation History

Comments / Questions: