Background Check Request Form

If you prefer, any or all information can be supplied via facsimile or telephone.
phone: 630-585-8430 fax: 630-978-1216

Date
Requestor	*
Phone	*
Email	*
Applicant Information
Applicant
Reference Number
Address
City
State
Zip
Phone
Alternate Phone
Date of Birth
Social Security Number
Type of Check
Criminal History	Education
Past Employment	Licenses and Certifications
Reference	Worker's Compensation History
Credit *	Other
If you require another type of search, please contact our office and we will be most happy to accommodate you. * Requires a signed release form from the applicant.
Employment / School Information
	Please list the information to be verified.
	Please list the information to be verified.
	Please list the information to be verified.

*required fields

1212 S. Naper Blvd.
Suite 119-163
Naperville, IL 60540

phone: 630-585-8430
fax: 630-978-1216