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User ID:

User Password:
Account Number:
Client Name:
Requester Name:
Requester Email:
Applicant Name:
Social Security Number:
Date of Birth:
Applicant Current Full Address:

Enter yes or no for the following options:
Social Security Database Search:

Criminal Record Search If yes, provide jurisdictions in same tab bar:
Education If yes, enter information below:
Degree or Diploma:
Date Received:
School Name, City and State:
Fifty State National Sex Offender Search:
Professional License or Certification Verification if yes, include number and state issued:
Credit History:
OFAC:
OIG: >
OFAC:

FACIS I, II AND/OR III:
Driving Record if yes, include number and state issued:


Employment If yes, enter information below:
Employer 1:
Address and Telephone Number:
Dates of Employment:
Applicant Title:
Name of Supervisor and contact info:
Employer 2:
Address and Telephone Number:
Dates of Employment:
Applicant Title:
Name of Supervisor and contact info:
Employer 3:
Address and Telephone Number:
Dates of Employment:
Applicant Title:
Name of Supervisor and contact info:
Employer 4:
Address and Telephone Number:
Dates of Employment:
Applicant Title:
Name of Supervisor and contact info: