<p> PAS ASSOCIATES Background Screening Request Form</p><p>Date: Client Name: Address: ______City/State: ______Zip Code:______Contact person: Telephone number: Fax number: </p><p>Enclosed is an authorization to coordinate the appropriate screening for the following subject:</p><p>Subject full name: </p><p>Date of Birth: / / Soc. Sec. No: </p><p>Basic Search Verifications and References Financial Reporting</p><p>Criminal County Search Employment Verification Credit History (Employment) </p><p>Social Security Number Trace Employment Verification Plus Liens & Judgments Civil Records Professional Reference Interview Motor Vehicle Information County Superior Court Search Management Reference Interview Additional Criminal Records Federal Court Search (District) Executive Reference Interview National Criminal Database Search Federal Court Search (Nationwide) Education Verification State Sexual Offender Registry Other Services Education Transcript Retrieval Federal Court Search (District) OFAC Foreign Nationals Search Professional License Verification Federal Court Search (Nationwide) State Workers' Compensation Military Service Records State Repository Records OIG Fraud Report (Healthcare) Prior Employer Drug & Alcohol Test Results State Incarceration Records </p><p>Special requests/comments </p><p>Signature of Requester Date </p><p>Mail/Fax to: PAS Associates, 1401 19th St., Ste. 420, Bakersfield, CA 93301 Telephone: 661-631-2165 Fax: 661-631-2841</p><p>P•A•S Associates has expertise in human resources and other areas involving employment issues. P•A•S Associates, in providing this form, does not represent that it is acting as an attorney or that it is giving any form of legal advice or legal opinion. P•A•S Associates recommends that before making any decision pertaining to human resource issues or employment issues, including the utilization of information contained on this website, the advice of legal counsel to determine the legal ramifications of the use of any such information be obtained.</p>