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SCREENING VERIFICATION INFORMATION

Please help me verify you are who you say you are. The more information you provide, the easier and faster this process will be. I make no exceptions to this process. The information you provide will be used discretely and will be discarded at the end of the process. Once verified, there is no need to do so again. I accept the following third party verification services RS2000, Date-Check, P411 or Indys. If you are a member that is all I require. If you are not a member, please give me as much information as you can or join one of these services. They are great.

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• EMPLOYMENT INFORMATION

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• AGENCY REFERENCE

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• PROVIDER REFERENCE #1

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• PROVIDER REFERENCE #2

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• SPECIAL INSTRUCTIONS

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