Background Screening Submission

Please fill out the below to build a request for a background check into the system.

Type of Request

Request Type

Is Drug Screening Required

Drug Screen Email

Individual rsponsible to coordinate screening

Zip Code of Drug Screening

Requester Informaton

Requester Name

Requester Title

Requester's Email

Classification

Company Division

Corporate Market

Wireless Market

Recovery Logistics Market

Customer

Comments

Please let us know if drug screening needs to be scheduled somewhere different than on the release form.

Applicant Information

First Name

Middle Name/Initial

Last Name

Suffix

Alias Or Other Used

Gender

Applicant Phone Number

Type Of Phone

Applicant Email

State In Which Applicant Will Work

Keep Applicant Name off daily internal distribution list?

Yes (keep confidential)No

Social Security Number

Date of Birth

Position Applied For

Driver's License Number

Driver License State of Issue

Is License a CDL (Commercial Drivers License)?

YesNo

Is a CDL Required For This Position

Eligibility Gate

STOP

DOES NOT MEET MINIMUM ELGIBILITY REQUIREMENTS FOR POSITION - YOU WILL NOT BE ABLE TO SUBMIT FORM

Present Street Address

Home Address

Apt, Suite, Etc

City

State

County

Zip

Background Authorization Form

Please attach

Background Authorization Form

Application Upload

Contact Information