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Post Office Box 644      Rome, GA 30162      1-877-235-7574      Facsimile: 706-235-6452
E-mail       www.psibackgroundcheck.com
 
BACKGROUND INVESTIGATION REPORT
Client:  Sample Client  Location: Sample Location
Subject:  JOHN ALLEN DOE
Researched:  SSN: 123-45-XXXX  Date of Birth: 01-Jan-####
SEX: Male  Race: White
Position Applied For:  Registered Nurse
Date Received:  17-Oct-2008
Date Returned:  18-Oct-2008
SOCIAL SECURITY NUMBER TRACE
Addresses provided by the applicant are consistent with our database findings with the exception of the following:
     215 Smith Road, Carrollton, GA, 30117
STATE CRIMINAL HISTORY
Alabama
Date of
Offense
Offense Classification Arresting
Agency
Disposition Sentence
10-Sep-2000 Driving Under The Influence (DUI) Misdemeanor Etowah Co SO Guilty Probation-12 Months, Fine-$659
10-Sep-2000 Disorderly Conduct Not Available Etowah Co SO Nolle Prossed (Dismissed) Not Available
10-Sep-2000 Driving With License Suspended or Revoked Misdemeanor Etowah Co SO Guilty Probation-12 Months, Fine-$659
10-Sep-2000 Marijuana-Simple Possession Not Available Etowah Co SO Nolle Prossed (Dismissed) Not Available
Arkansas
*** No record on file ***
Georgia
Date of
Offense
Offense Classification Arresting
Agency
Disposition Sentence
12-Feb-2001 Aggravated Assault Felony Floyd Co SO Guilty Confined 60 Days,
Fine $1,000 and
Restitution
10-Jan-2000 Driving Under The Influence (DUI) Misdemeanor Rome PD Guilty Probation-12 Months,
Fine-$589
10-Jan-2000 Obstruction of Officers Not Available Rome PD Nolle Prossed (Dismissed) Not Available
Pennsylvania
Date of
Offense
Offense Classification Arresting
Agency
Disposition Sentence
05-Apr-1998 Driving With License Suspended
or Revoked
Misdemeanor Pennsylvania State Patrol Guilty Probation-6 Months,
Fine-$550
STATE SEX OFFENDER
Alabama
*** No record on file ***
Arkansas
*** No record on file ***
Georgia
*** No record on file ***
Pennsylvania
*** No record on file ***
INTERNATIONAL CRIMINAL HISTORY
India
*** No record on file ***
FEDERAL DISTRICT CRIMINAL HISTORY
Alabama
*** No record on file ***
Arkansas
*** No record on file ***
Georgia
Case Summary
4:97-mj-01118-WS USA v. Doe
Date filed: 10/24/1997
Date terminated: 10/24/1997
John D. Doe (1)
Office:  Columbus  Filed:  10/24/1997
County:   Terminated: 10/24/1997 Reopened: 
Other Court Case:  None
Count:  1  Citation:  18:13-7220.M  Offense Level: 3
     18:13-7220.M TRAFFIC OFFENSES, OTHER
Def Custody Status:
Plaintiff   USA represented by  Signa R. Olivette  Phone: 706-545-7026
Pennsylvania
*** No record on file ***
NATIONAL SEX OFFENDER
 
***No record on file***
FEDERAL DISTRICT CIVIL HISTORY
ARKANSAS
1:95-cv-00016-WRW-HLJKnox v. Doe, et al
William R. Willis, Jr, presiding
Henry L. Jones, Jr, referral
Date filed: 01/24/1995
Date terminated: 01/17/1996 Date of last filing: 01/17/1996
Case Summary
Office:  Batesville Filed:  01/24/1995
Jury Demand:  None Demand:  $0
Nature of Suit:  550 Cause:  42:1983 Prisoner Civil Rights
JJurisdiction:  Federal Question Disposition:  Dismissed - Want of Prosecution
County:  Izard Terminated:  01/17/1996
Origin:  1 Reopened: 
Lead Case:  None  
Related Case:  None Other Court Case:  None
Def Custody Status: 
Def Custody Status:  DISC, TERMED  
Plaintiff Curtis Knox 
Defendant Larry Norton  represented by Phone:  (501) 661-2609
Defendant Larry Mays  represented by Phone:  (501) 661-2609
Defendant John Doe  represented by Phone:  (501) 661-2609
HHS/OIG--List of Excluded Individuals/Entities Search
*** No record on file ***
GSA
Excluded Parties Listing System
Court Action
Class Record Type Exclusion Type Description Date Code Agency Term Date
Individual Primary Reciprocal --- 09-Aug-2000 R OPM
MOTOR VEHICLE REPORT
GEORGIA
For your convenience we copy and paste the report from the state Department of Motor Vehicle repository. We do this because insurance companies commonly request an original copy of the applicant's driver history. This report includes verification of driver's license status and expiration date. Records of accidents and violations are also provided. This report is based on records from state Department of Motor Vehicle bureaus and typically includes three to seven years of history, depending on the state.
BANKRUPTCY
ALABAMA
98-70869-rcm7 John D. Doe
Case type:  bk Chapter:  7 Asset:  No Vol:  v Judge:  Robert C. McGuiness
Date filed:  08/18/1998 Date discharged:  12/22/1998
Date terminated:  12/31/1998 Date of last filing:  12/31/1998
Case Summary
Office:  Wichita Falls Filed:  08/18/1998
County:  Wichita Terminated:  12/31/1998
Fee:  Paid Discharged:  12/22/1998
Reopen:  0 Reopened: 
Previous:  Converted: 
Term: 
Disposition:  Discharge Granted Dismissed: 
Joint:  y Confirmation: 
Hearing: 
Pending Status:  Case Closed
Flags:  CLOSED
Trustee:  Harry L. Curey City:  Ft. Worth
Phone:  817-332-1174
Party 1:  John D. Doe (xxx-xx-0465) (Debtor)
Atty:  John Edward Smith Represents party 1:  Debtor
Phone:  940-723-0099
Fax:  940-723-0096
Email:  legal@montejwhite.com
EDUCATION VERIFICATION
School/College Start End Graduation Degree/Certificate/Diploma Course of Study
Auburn University
(Accredited by: Southern Association of Colleges and Schools)
19-Aug-1998 25-May-2002 25-May-2002 Bachelor of Science in
Nursing
Nursing
Chattanooga State Technical Community College
(Accredited by: Southern Association of Colleges and Schools)
Jan-1995 May-1997 Jun-1997 Associate of Arts English
PROFESSIONAL LICENSE/CERTIFICATION
Date(s)
License Type License Number License Issued Expiration Status
RN (GA) 123456 14-Jun-2002 31-Dec-2006 Active
ORGANIZATIONAL MEMBERSHIP
Date(s)
Organization Start End Status
UNICEF 25-May-2002 31-Dec-2006 Active Member
REFERENCE(S)
Employee Reference: 1 of 1
Name:  Metro Medical Center
Address:  400 Highway 118, Atlanta, GA
Telephone:  (404) 555-5555
Job Title: 
According to Applicant: Registered Nurse
According to Employer: Registered Nurse
Start and End Dates: 
According to Applicant: Feb-2004 Aug-2004
According to Employer: 16-Feb-2004 25-May-2004
Respondent Name: 
 Ms. Gloria Smith Date Employment Verified: 26-Dec-05
Respondent Title: 
 Director of Nursing
Reason for Leaving: 
According to Applicant: Personal Reasons
According to Employer: "He was let go because of his job performance."
Eligibility for Rehire:  Not Eligible
Comments...  Degree of supervision needed: 5 on a scale of 1 to 10. "A lot; he would be sitting around reading a magazine when he was supposed to be making rounds."
Dependability: 6 on a scale of 1 to 10. "He was dependable most of the time, but there were a few times when he didn't show up at all for his shift."
Maturity: 5 on a scale of 1 to 10. "He acts a little young for his age. He likes to play jokes on people."
Overall attitude: 9 on a scale of 1 to 10. "He has a very good attitude. He seems to always be in a good mood."
Overall work quality: 7 on a scale of 1 to 10. "He seems to give it his all while at work. I've never noticed him slacking on the job."
Relationship with co-workers and supervisors: 8 on a scale of 1 to 10. "Good. While he is not the most mature person, he does get along well with others." 
Recommendation:  Does Not Recommend--"He is irresponsible, and frankly not the kind of person I would want working as a nurse. He is not very trustworthy because there were times when I counted on him to do certain tasks and he didn't even complete them
Additional  Comments:  Ms. Smith said that she doesn't know how Mr. Doe became a nurse in the first place. She described him as "incompetent for the job".
Social Reference: 1 of 1
Name:  Jane Smith
Age:  51
Occupation:  Physician
Address:  230 Dole Dr., Atlanta, GA 30303
Telephone:  (770)555-5555
Date Contacted:  26-Dec-05
Relationship/Length: 
According to Applicant: 20 years Relationship Type: Family Friend
According to Acquaintance: 19 years Relationship Type: Family Friend
Comments...  Dependability: 7 on a scale of 1 to 10. "He is dependable when it's something he cares about."
Maturity: 6 on a scale of 1 to 10. "Below average for his age."
Overall attitude: 5 on a scale of 1 to 10. "He is angered easily."
Recommendation:  Unable To Make Recommendation--"I don't really feel comfortable giving him a recommendation. He is a good guy, but he has had numerous jobs over the past few years and I just do not know if he would stick with it."
Additional Comments:  When Dr. Smith was asked if there was anything negative about Mr. Doe she said "he did some partying and things when he was young, but I think maybe he has grown out of it."
Neighbor Reference: 1 of 1
Name:  George Williams
Age:  45
Address:  200 East 10th St., Rome, GA 30161
Telephone:  (706)555-5555
Date Contacted:  26-Dec-05
Relationship/Length: 
According to Applicant: 3 years Relationship Type: Neighbor
According to Neighbor: 2 1/2 to 3 years Relationship Type: Next Door Neighbor
Comments...  Dependability: Not Available
Maturity: Not Available
Overall attitude: Not Available
Recommendation:  Unable To Make Recommendation--Mr. Williams did not feel that he knew Mr. Doe well enough to make a recommendation.
Additional  Comments:  "I don't know much about him, but there are always a lot of strange people at his house."
CREDIT REPORT
THE FOLLOWING ACCOUNT INFORMATION IS PRINTED IN ORDER BY MOST NEGATIVE MANNER OF PAYMENT (MOP) AND DATE MOST RECENTLY UPDATED.
  RICHS/FDSB
D 2342001
REVOLVING ACCOUNT
CHARGE ACCOUNT
VERIF'D 12/2002 BALANCE: $0 INDIVIDUAL ACCOUNT
OPENED 08/1997 MOST OWED: $769 CREDIT LIMIT: $800
STATUS AS OF 08/1998: PAID OR PAYING AS AGREED IN PRIOR 12 MONTHS FROM DATE PAID NEVER LATE
  RICHS/FDSB
D 2342001
REVOLVING ACCOUNT
CHARGE ACCOUNT
VERIF'D 12/2002 BALANCE: $0 PARTICIPANT ON ACCOUNT
OPENED 11/1998 MOST OWED: $0 CREDIT LIMIT: $1500
STATUS AS OF 02/1999: PAID OR PAYING AS AGREED IN PRIOR 02 MONTHS FROM DATE PAID NEVER LATE
  MBNA AMERICA
  ACCT CLSD BY CONSUMER
B 1597029
REVOLVING ACCOUNT
CREDIT CARD
VERIF'D 12/2002 BALANCE: $3249 INDIVIDUAL ACCOUNT
OPENED 09/1999 MOST OWED: $15866 PAY TERMS: MINIMUM $15
CREDIT LIMIT: $16000
STATUS AS OF 12/2002: PAID OR PAYING AS AGREED IN PRIOR 39 MONTHS FROM DATE VERIF'D NEVER LATE
  SUNTRUST MTG
B 3122001
MORTGAGE ACCOUNT
CONVENTIONAL REAL ESTATE MTG
VERIF'D 12/2002 BALANCE: $114455 JOINT ACCOUNT
OPENED 05/2000 MOST OWED: $117250 PAY TERMS: 360 MONTHLY $993
STATUS AS OF 12/2002: PAID OR PAYING AS AGREED IN PRIOR 30 MONTHS FROM DATE VERIF'D NEVER LATE
  RICHS/FDSB
D 2342001
REVOLVING ACCOUNT
CHARGE ACCOUNT
VERIF'D 12/2002 BALANCE: $0 INDIVIDUAL ACCOUNT
OPENED 10/1997 MOST OWED: $0
STATUS AS OF 12/2002: PAID OR PAYING AS AGREED IN PRIOR 29 MONTHS FROM DATE VERIF'D NEVER LATE
  FIRST USA BK
B 7519149
REVOLVING ACCOUNT
CREDIT CARD
VERIF'D 12/2002 BALANCE: $54 INDIVIDUAL ACCOUNT
OPENED 11/2000 MOST OWED: $11627 PAY TERMS: MINIMUM $10
CREDIT LIMIT: $900
STATUS AS OF 12/2002: PAID OR PAYING AS AGREED IN PRIOR 39 MONTHS FROM DATE VERIF'D NEVER LATE
  PIER ONE
D 8381001
REVOLVING ACCOUNT
CHARGE ACCOUNT
VERIF'D 12/2002 BALANCE: $63 INDIVIDUAL ACCOUNT
OPENED 04/2001 MOST OWED: $434 PAY TERMS: MINIMUM $15
CREDIT LIMIT: $1100
STATUS AS OF 12/2002: PAID OR PAYING AS AGREED IN PRIOR 20 MONTHS FROM DATE VERIF'D NEVER LATE
OFAC - List of Specially Designated Nationals and Blocked Persons
*** No record on file ***
MISCELLANEOUS INFORMATION

We conducted a Social Security Number search and found the applicant had resided in three states other than Georgia. The three states we located are as follows: Alabama, Pennsylvania, and Arkansas. A criminal history was located in Georgia and Pennsylvania.

DISCLAIMER

The records contained in our reports are compiled from various databases that may only be updated infrequently, and therefore, may not have the most current information. Our reports are not intended to serve as recommendations of whether to hire the individuals investigated. 

Our reports are submitted in strict confidence and except where required by law, no information provided in our reports may be revealed directly or indirectly to any person except to those whose official duties require them to pass this report on in relation to which the report was requested by the client.

Professional Screening & Information, Inc. neither warrants, vouches for, or authenticates the reliability of the information contained herein that the records are accurately reported as they were found at the source as of the date and time of this report, whether on a computer information system, retrieved by manual search, or telephonic interviews. The information provided herein shall not be construed to constitute a legal opinion; rather it is a compilation of public records and/or data for your review. Professional Screening & Information, Inc. shall not be liable for any losses or injuries now or in the future resulting from or relating to the information provided herein.

Our report contains public record information that is reportable under the Fair Credit Reporting Act or other federal or state laws. However, the intended use of this information by the user may be restricted by separate state and/or local laws.

A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT

The federal Fair Credit Reporting Act (FCRA) is designed to promote accuracy, fairness, and privacy of information in the files of every "consumer reporting agency" (CRA). Most CRAs are credit bureaus that gather and sell information about you -- such as if you pay your bills on time or have filed bankruptcy -- to creditors, employers, landlords, and other businesses. You can find the complete text of the FCRA, 15 U.S.C. 1681-1681u, at the Federal Trade Commission's website (http://www.ftc.gov). The FCRA gives you specific rights, as outlined below. You may have additional rights under state law. You may contact a state or local consumer protection agency or a state attorney general to learn those rights.

You must be told if information in your file has been used against you. Anyone who uses information from a CRA to take action against you -- such as denying an application for credit, insurance, or employment -- must tell you, and give you the name, address, and phone number of the CRA that provided the consumer report.

You can find out what is in your file. At your request, a CRA must give you the information in your file, and a list of everyone who has requested it recently. There is no charge for the report if a person has taken action against you because of information supplied by the CRA, if you request the report within 60 days of receiving notice of the action. You also are entitled to one free report every twelve months upon request if you certify that (1) you are unemployed and plan to seek employment within 60 days, (2) you are on welfare, or (3) your report is inaccurate due to fraud. Otherwise, a CRA may charge you up to eight dollars.

You can dispute inaccurate information with the CRA. If you tell a CRA that your file contains inaccurate information, the CRA must investigate the items (usually within 30 days) by presenting to its information source all relevant evidence you submit, unless your dispute is frivolous. The source must review your evidence and report its findings to the CRA. (The source also must advise national CRAs -- to which it has provided the data -- of any error.) The CRA must give you a written report of the investigation, and a copy of your report if the investigation results in any change. If the CRA's investigation does not resolve the dispute, you may add a brief statement to your file. The CRA must normally include a summary of your statement in future reports. If an item is deleted or a dispute statement is filed, you may ask that anyone who has recently received your report be notified of the change.

Inaccurate information must be corrected or deleted. A CRA must remove or correct inaccurate or unverified information from its files, usually within 30 days after you dispute it. However, the CRA is not required to remove accurate data from your file unless it is outdated (as described below) or cannot be verified. If your dispute results in any change to your report, the CRA cannot reinsert into your file a disputed item unless the information source verifies its accuracy and completeness. In addition, the CRA must give you a written notice telling you it has reinserted the item. The notice must include the name, address and phone number of the information source.

You can dispute inaccurate items with the source of the information. If you tell anyone -- such as a creditor who reports to a CRA -- that you dispute an item, they may not then report the information to a CRA without including a notice of your dispute. In addition, once you've notified the source of the error in writing, it may not continue to report the information if it is, in fact, an error.

Outdated information may not be reported. In most cases, a CRA may not report negative information that is more than seven years old; ten years for bankruptcies

Access to your file is limited. A CRA may provide information about you only to people with a need recognized by the FCRA -- usually to consider an application with a creditor, insurer, employer, landlord, or other business.

Your consent is required for reports that are provided to employers, or reports that contain medical information. A CRA may not give out information about you to your employer, or prospective employer, without your written consent. A CRA may not report medical information about you to creditors, insurers, or employers without your permission.

You may choose to exclude your name from CRA lists for unsolicited credit and insurance offers. Creditors and insurers may use file information as the basis for sending you unsolicited offers of credit or insurance. Such offers must include a toll-free phone number for you to call if you want your name and address removed from future lists. If you call, you must be kept off the lists for two years. If you request, complete, and return the CRA form provided for this purpose, you must be taken off the lists indefinitely.

You may seek damages from violators. If a CRA, a user or (in some cases) a provider of CRA data, violates the FCRA, you may sue them in state or federal court.

The FCRA gives several different federal agencies authority to enforce the FCRA:
FOR QUESTIONS OR CONCERNS REGARDING: PLEASE CONTACT:
CRAs, creditors and others not listed below Federal Trade Commission
Consumer Response Center - FCRA
Washington, DC 20580
202-326-3761
National banks, federal branches/agencies of foreign banks(word "National" or initials "N.A." appear in or after bank's name) Office of the Comptroller of the Currency
Compliance Management, Mail Stop 6-6
Washington, DC 20219
800-613-6743
Federal Reserve System member banks (except national banks,and federal branches/agencies of foreign banks) Federal Reserve Board
Division of Consumer & Community Affairs
Washington, DC 20551
202-452-3693
Savings associations and federally chartered savings banks (word"Federal" or initials "F.S.B." appear in federal institution's name) Office of Thrift Supervision
Consumer Programs
Washington, DC 20552
800-842-6929
Federal credit unions (words "Federal Credit Union" appear ininstitution's name) National Credit Union Administration
1775 Duke Street
Alexandria, VA 22314
703-518-6360
State-chartered banks that are not members of the Federal Reserve System Federal Deposit Insurance Corporation
Division of Compliance & Consumer Affairs
Washington, DC 20429
800-934-FDIC
Air, surface, or rail common carriers regulated by former Civil Aeronautics Board or Interstate Commerce Commission Department of Transportation
Office of Financial Management
Washington, DC 20590
202-366-1306
Activities subject to the Packers and Stockyards Act, 1921 Department of Agriculture
Office of Deputy Administrator - GIPSA
Washington, DC 20250
202-720-7051
Questions and/or consumer referrals may be made to:
Professional Screening & Information, Inc.
Post Office Box 644
Rome, GA 30162
Telephone (toll free): 1-877-235-7574
-- End of Report --
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