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Post Office Box 644 Rome, GA 30162 1-877-235-7574 Facsimile: 706-235-6452
E-mail www.psibackgroundcheck.com |
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| BACKGROUND INVESTIGATION REPORT |
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| 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 |
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| SOCIAL SECURITY NUMBER TRACE |
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Addresses provided by the applicant are consistent with our database findings with the exception of the following:
215 Smith Road, Carrollton, GA, 30117
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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 |
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| *** No record on file *** |
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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 |
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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 |
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| *** No record on file *** |
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| *** No record on file *** |
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| *** No record on file *** |
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| *** No record on file *** |
| INTERNATIONAL CRIMINAL HISTORY |
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| *** No record on file *** |
| FEDERAL DISTRICT CRIMINAL HISTORY |
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| *** No record on file *** |
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| *** No record on file *** |
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Case Summary
4:97-mj-01118-WS USA v. Doe
Date filed: 10/24/1997
Date terminated: 10/24/1997 |
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| John D. Doe (1) |
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| Office: |
Columbus |
Filed: 10/24/1997 |
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| County: |
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Terminated: 10/24/1997 |
Reopened: |
| Other Court Case: |
None |
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| Count: |
1 |
Citation: 18:13-7220.M |
Offense Level: 3 |
| 18:13-7220.M TRAFFIC OFFENSES, OTHER |
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| Def Custody Status: |
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| Plaintiff |
USA |
represented by |
Signa R. Olivette |
Phone: 706-545-7026 |
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| *** No record on file *** |
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| NATIONAL SEX OFFENDER |
| |
| ***No record on file*** |
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| FEDERAL DISTRICT CIVIL HISTORY |
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ARKANSAS
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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 |
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Case Summary
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| 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: |
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| Lead Case: |
None |
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| Related Case: |
None |
Other Court Case: |
None |
| Def Custody Status: |
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| Def Custody Status: |
DISC, TERMED |
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| Plaintiff Curtis Knox |
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| 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 |
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| HHS/OIG--List of Excluded Individuals/Entities Search |
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| *** No record on file *** |
| GSA |
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| Excluded Parties Listing System |
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Court Action |
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| Class |
Record Type |
Exclusion Type |
Description |
Date |
Code |
Agency |
Term Date |
|
| Individual |
Primary |
Reciprocal |
--- |
09-Aug-2000 |
R |
OPM |
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| MOTOR VEHICLE REPORT |
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| 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 |
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| ALABAMA |
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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 |
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Case Summary
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| Office: |
Wichita Falls |
Filed: |
08/18/1998 |
| County: |
Wichita |
Terminated: |
12/31/1998 |
| Fee: |
Paid |
Discharged: |
12/22/1998 |
| Reopen: |
0 |
Reopened: |
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| Previous: |
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Converted: |
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| Term: |
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| Disposition: |
Discharge Granted |
Dismissed: |
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| Joint: |
y |
Confirmation: |
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Hearing: |
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| Pending Status: |
Case Closed |
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| Flags: |
CLOSED |
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| Trustee: |
Harry L. Curey |
City: |
Ft. Worth |
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Phone: |
817-332-1174 |
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| Party 1: |
John D. Doe (xxx-xx-0465) (Debtor) |
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| Atty: |
John Edward Smith |
Represents party 1: |
Debtor |
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Phone: |
940-723-0099 |
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Fax: |
940-723-0096 |
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Email: |
legal@montejwhite.com |
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| EDUCATION VERIFICATION |
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| 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 |
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| PROFESSIONAL LICENSE/CERTIFICATION |
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Date(s) |
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| License Type |
License Number |
License Issued |
Expiration |
Status |
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| RN (GA) |
123456 |
14-Jun-2002 |
31-Dec-2006 |
Active |
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| ORGANIZATIONAL MEMBERSHIP |
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Date(s) |
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| Organization |
Start |
End |
Status |
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| UNICEF |
25-May-2002 |
31-Dec-2006 |
Active Member |
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| Employee Reference: 1 of 1 |
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| Name: |
Metro Medical Center |
| Address: |
400 Highway 118, Atlanta, GA |
| Telephone: |
(404) 555-5555 |
| Job Title: |
| According to Applicant: Registered Nurse |
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| According to Employer: Registered Nurse |
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| Start and End Dates: |
| According to Applicant: Feb-2004 |
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Aug-2004 |
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| According to Employer: 16-Feb-2004 |
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25-May-2004 |
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| Respondent Name: |
| Ms. Gloria Smith |
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Date Employment Verified: 26-Dec-05 |
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| Respondent Title: |
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| Reason for Leaving: |
| According to Applicant: Personal Reasons |
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| According to Employer: "He was let go because of his job performance." |
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| 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". |
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| Social Reference: 1 of 1 |
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| 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 |
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Relationship Type: Family Friend |
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| According to Acquaintance: 19 years |
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Relationship Type: Family Friend |
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| 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." |
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| Neighbor Reference: 1 of 1 |
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| 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 |
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Relationship Type: Neighbor |
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| According to Neighbor: 2 1/2 to 3 years |
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Relationship Type: Next Door Neighbor |
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| 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." |
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| CREDIT REPORT |
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| THE FOLLOWING ACCOUNT INFORMATION IS PRINTED IN ORDER BY MOST NEGATIVE MANNER
OF PAYMENT (MOP) AND DATE MOST RECENTLY UPDATED. |
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| 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 |
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| 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 |
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| OPENED |
11/1998 |
MOST OWED: |
$0 |
CREDIT LIMIT: |
$1500 |
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| 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 |
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| OPENED |
09/1999 |
MOST OWED: |
$15866 |
PAY TERMS: |
MINIMUM $15 |
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CREDIT LIMIT: |
$16000 |
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| 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 |
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| OPENED |
05/2000 |
MOST OWED: |
$117250 |
PAY TERMS: |
360 MONTHLY $993 |
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| 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 |
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| OPENED |
10/1997 |
MOST OWED: |
$0 |
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| 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 |
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| OPENED |
11/2000 |
MOST OWED: |
$11627 |
PAY TERMS: |
MINIMUM $10 |
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CREDIT LIMIT: |
$900 |
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| 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 |
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| OPENED |
04/2001 |
MOST OWED: |
$434 |
PAY TERMS: |
MINIMUM $15 |
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CREDIT LIMIT: |
$1100 |
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| STATUS AS OF 12/2002: PAID OR PAYING AS AGREED IN PRIOR 20 MONTHS FROM DATE VERIF'D NEVER LATE |
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| OFAC - List of Specially Designated Nationals and Blocked Persons |
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| *** No record on file *** |
| MISCELLANEOUS INFORMATION |
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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. |
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| 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. |
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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. |
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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. |
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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. |
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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. |
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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. |
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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 |
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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. |
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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. |
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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. |
|
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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. |
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| The FCRA gives several different federal agencies authority to enforce the FCRA: |
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| 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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| Thank you for choosing PSI for your professional background investigative services. |
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