SAMPLE REPORT 2

TABB INC.

HUMAN RESOURCE SERVICES SERVICE IS OUR NUMBER ONE PRIORITY

555 E. Main St., Chester, NJ 07930

TELEPHONE(908)879-2323/FAX NO. (908) 879-8675

www.tabb.net

The information contained in this report is for the SOLE AND CONFIDENTIAL use of the subscriber.

DATABASE:

A database search conducted under the applicant's Social Security Number show the name ……………… and the following cities and states as addresses for the applicant: Union, Hillside, NJ; Tobyhanna, PA; Miami, FL

CRIMINAL REPORT: RECORD

The applicant resides in New Jersey. A statewide criminal record search was conducted in New Jersey under the applicant's name. There is no record of a felony or misdemeanor conviction under the applicant's name and date of birth.

The applicant formerly resided in Pennsylvania. A statewide criminal record search was conducted in Pennsylvania. There is no record of a felony or misdemeanor conviction under the applicant's name and date of birth.

A statewide criminal record search was conducted in Florida. Please see the attached results found in a search conducted of Florida State records under the applicant's name and the date of birth. Please see the attached pages.

Please check the identity of your applicant with the identifiers developed in this record and contact the applicant to confirm this information. If the applicant disputes this record, further research must be conducted by TABB INC. Please contact our office if there is a dispute.

EMPLOYMENT:

XYZ Hospital Dates Given: 2003 - Present

Dates Confirmed: 6/02 /03 - Present

Ms. ……………., Human Resources Assistant, responded indicating the applicant has been employed as a full time Respiratory Care Technician since 6/02/03. In response to the Health Care Profession Responsibility and Reporting Enhancement Act, Ms. …………… did not respond to questions regarding the applicant's work performance, and if the applicant was reported to a licensing agency. Attached is a copy of the response. The applicant's supervisor, Mr………….., Manager, stated the applicant has been employed as a full time Respiratory Therapist for four years. The candidate provides basic respiratory treatment. The applicant's performance is described as "okay". When Ms……….. first started, the applicant was slow but has gotten better. Ms. ……….. basic respiratory therapy skills are average and the applicant cannot do the additional "first step forward" according to Mr. ……….. The applicant has weak decision making skills and has difficulty knowing "the things that will happen." The applicant is adequate with patients but Mr. ……….. has heard some complaints. There are no complaints that have been written or reportable. The complaints are due to her communication skills. The applicant doesn't interact well with patients, which is "just her nature." Ms. ………. has fair communications with coworkers but seems to be "secretive" and also doesn't interact well with them. If Mr. ………. Instructs the applicant to do something, the applicant will do it. There have been problems with attendance and Ms. ………. has been given a written warning. In response to the Health Care Professional Responsibility and Reporting Enhancement Act Mr. ………… verified that the facility has not provided any notice to the licensing board or to the review panel with respect to this applicant's impairment, incompetence, professional misconduct, involvement in adverse patient care or safety, involvement in drug or alcohol abuse, involvement in intervention programs or any other issue as it relates to patient care or safety.

ABC Hospital Dates Given: 5/06 - Present

Dates Confirmed: 9/21/07 - Present

The policy of this employer requires that all requests for verification of employment must be submitted in writing. We complied and Ms. ………….., Human Resources Clerk, responded indicating the applicant has been employed as a per diem Registered Respiratory Therapist since 9/21/07. The applicant's professional skills and abilities relating to patient care meet standards. The applicant is eligible for re-employment by the health care entity. In response to the Health Care Professional Responsibility and Reporting Enhancement Act Ms. ……………. verified that the facility has not provided any notice to the licensing board or to the review panel with respect to this applicant's impairment, incompetence, professional misconduct, involvement in adverse patient care or safety, involvement in drug or alcohol abuse, involvement in intervention programs or any other issue as it relates to patient care or safety. Attached is a copy of the response. The applicant's supervisor, Ms. …………., Respiratory Care Manager, stated the applicant is currently employed as a per diem Respiratory Therapist working nights. The applicant is responsible for patient care in the Critical Care Unit including ventilator management, oxygen therapy and assessing the patient. The candidate has only recently started at the hospital and has only worked a few shifts. From what can be observed at this point, the applicant performs very well and is very responsible, motivated and requires minimal supervision. The applicant's skills are very good however, Ms. …………. does not know about the applicant's neonatal skills, as this hospital does not have many neonatal patients. There are no problems with attendance or punctuality. The applicant has never had any complaints from patients and works well with coworkers. In response to the Health Care Professional Responsibility and Reporting Enhancement Act Ms. …………… verified that the facility has not provided any notice to the licensing board or to the review panel with respect to this applicant's impairment, incompetence, professional misconduct, involvement in adverse patient care or safety, involvement in drug or alcohol abuse, involvement in intervention programs or any other issue as it relates to patient care or safety.

REPORT BY: ZA