Employment Screening Application

Please use the forward and back buttons provided at the bottom of each page when moving back and forth through the form. Using your browser's back button can result in you losing everything you have typed into the form.

Last Name(*)
Invalid Input

First Name(*)
Invalid Input

Spouse Last Name
Invalid Input

Spouse First Name
Invalid Input

Resident Address(*)
Invalid Input

City/State(*)
Invalid Input

Zip Code(*)
Invalid Input

Telephone No(*)
Invalid Input

Email Address(*)
Invalid Input

Company Your Are Applying To
Invalid Input

Please check what screening option your prospective employer requires.

Please note: Your prospective employer will advise as to which option applies. Not all applicants are required to fill out this field. If you were not directed to choose an option please disregard.

Screening Option

Invalid Input

 
Page 2 of 10
Type of Residence
Invalid Input

Length of Residency
Invalid Input

Monthly Rent/Mortgage
Invalid Input

If you are renting, please supply the name and address of the landlord:
Landlords Name
Invalid Input

Address
Invalid Input

City, State, Zip
Invalid Input

Telephone Number
Invalid Input

 
Page 3 of 10
Please enter your previous residence addresses, along with the dates you lived there
1
Invalid Input

2
Invalid Input

 
Page 4 of 10
Do you own real estate elsewhere?
Invalid Input

If so please give the location
Invalid Input

length of ownership
Invalid Input

 
Page 5 of 10
Date of Birth(*)
Invalid Input

Drivers License No
Invalid Input

State Where Issued
Invalid Input

Marital Status
Invalid Input

Social Security No
Invalid Input

Number of Dependents
Invalid Input

Please list the name and age of each dependent
Invalid Input

 
Page 6 of 10
Current Employer
Invalid Input

Employer Address
Invalid Input

Employer Telephone No
Invalid Input

Date of Hire
Invalid Input

Position
Invalid Input

Annual Salary
Invalid Input

Bonus
Invalid Input

Commissions
Invalid Input

Tips
Invalid Input

Name of Supervisor
Invalid Input

Contact Phone No
Invalid Input

Dates Employed From
Invalid Input

Dates Employed Too
Invalid Input

 
Page 7 of 10
If you are/were self-employed, please answer the following section
Business Name
Invalid Input

Tax Identification No
Invalid Input

Self Employed Address
Invalid Input

Income
Invalid Input

Bonus/Other
Invalid Input

 
Page 8 of 10

CIVIL CASES:

Please list any civil cases in which you are/were a plaintiff or a defendant:
Case Caption
Invalid Input

Docket/Index Number:
Invalid Input

Case Caption
Invalid Input

Docket/Index Number:
Invalid Input

 
Page 9 of 10

CRIMINAL COURT CASES:

Please list any pending criminal cases or past criminal convictions:
Case Caption
Invalid Input

Docket/Index Number:
Invalid Input

Case Caption
Invalid Input

Docket/Index Number:
Invalid Input

LIENS/JUDGMENTS
Please list any liens/judgments filed against you
Details
Invalid Input

 
Last Page ;)

In connection with, prior to and after my application for Employment I understand that investigative background inquiries will be made on myself. That may include consumer, criminal, Department of Motor Vehicle records, civil records, and other records. These reports may include information as to my character, work habits, performance along with reasons for termination of past employment. Further, I understand that you may be requesting information from various Federal, State and other agencies which maintain records concerning past employment, driving, criminal or civil records, credit information, credit profiles and credit scores. Incomplete, inaccurate, omitted or misleading information is cause for rejection of application.

This information is being requested by Metropolitan Investigative Group, LLC. or their authorized agent. By hitting submit, I hereby authorize, without reservation, any party contacted to furnish the above information. Furthermore, by hitting submit I fully accept the preceding agreement.

Electronic Signature(*)
Invalid Input

Your typed signature above indicates your agreement and authorization to the above.
Are you Human
Invalid Input