Background Screening Submission

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

Type of Request

In-House/Subcontractor

Please select if this is an in-house applicant or a subcontractor technician.

Request Type

Requester Informaton

Requester First Name

Requester Last Name

Requester's Email

Subcontractor Company Name

Please make sure to select/click on the name to ensure link to database.

Subcontractor ID

Drug Screening Email

Classification

Company Division

Corporate Market

Wireless Market

Wireline Market

Fulfillment Market

Renewables Market

Customer

Region

Area Leader

Also badge for Altice?

YesNo

Altice if Comcast

Also badge for Comcast?

YesNo

Comcast if Altice

Also a badge for Buckeye?

YesNo

Check if Verizon One Project

Yes

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

Applicant's Email Address

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

Is License a CDL (Commercial Drivers License)?

YesNo

Driver License State

Present Address

Home Address

City

State

Zip

Company Transferring From

Previous Tech ID Number

Send Badge to:

Picture of Drivers License

Subcontractor Badge Details

Warning: Subcontractors not APPROVED will not have badges printed.

First and Last Name (only) exactly as it appears on Driver License or Legal ID. Include suffixes, Jr. etc.

First and Last Name

Job Title

ID Badge

The headshot should be exactly like a passport or drivers license photo:

Neutral background
No Selfies
No image altering filters
No sunglasses
No hats/accessories obscuring view
Facing directly forward
Not blurry

The frame of the picture only needs to be from the shoulders up, so either zoom in or stand closer.

Any unacceptable photo submissions will delay the badging process.

Badge Headshot Photo

U-Verse AT&T Only

Shirt Size

Subcontractor employees may decline to provide their vaccination status by selecting the “Declined to answer” option. If employees decline to provide their vaccination status, the Company will assume that they are unvaccinated for purposes of workplace and/or customer requirements that are different for vaccinated and unvaccinated employees. This includes access to certain customer facilities and job sites.

Vaccination Status

Tools

Background Submission completed by you for Cox Communications work

Please attach a copy of the backgrounds results email from InfoMart. Any alteration or editing of InfoMart's email will be considered a fraudulent misrepresentation.

InfoMart Results Email

Sumission done by Sub

Driver's License

Please attach a copy of driver's license to confirm information.

Copy/Photo of License

I-9 Verification Confirmation

Please attach your I-9 Verification Confirmation Form.

I-9 Verification Confirmation

EXAMPLE of attachment:

Social Security Card

Please attach to verify Social Security Number.

Social Security Card

Background Authorization Form

Please attach

Background Authorization Form

CrimShield Authorization Form

Please attach

CrimShield Authorization Form

Education & Employment Verification

Please attach

Education & Employment Verification

Phase II Authorization

Please attach

Phase II Authorization

Canada Attachments

Canada MVR

Canada Background Check

Canada New Hire Packet

About your Personal Information

The information you provide here will be processed solely for the purpose of submitting customer required background and drug screenings. Your personal information will be accessed only by our Risk Management staff.

Contact Information