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 ***
DRUG SCREENING RESULTS
 
***Negative***
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

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.

This 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) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to www.consumerfinance.gov/learnmore

Para informacion en espanol, visite www.consumerfinance.gov/learnmore o escribe a la Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20006.

  • You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment - or to take another adverse action against you - must tell you, and must give you the name, address, and phone number of the agency that provided the information.

  • You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your "file disclosure"). You will be required to provide proper identification, which may include your Social Security Number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:

        • A person has taken adverse action against you because of information in your credit report;
        • You are the victim of identity theft and place a fraud alert in your file;
        • Your file contains inaccurate information as a result of fraud;
        • You are on public assistance;
        • You are unemployed but expect to apply for employment within 60 days.

    In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.consumerfinance.gov/learnmore for additional information.

  • You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit score information for free from the mortgage lender.

  • You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is frivolous. See www.consumerfinance.gov/learnmore for an explanation of dispute procedures.

  • Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report information it has verified as accurate.

  • Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old.

  • Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need - usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a valid need for access.

  • You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potential employer, without your written consent given to the employer. Written consent generally is not required in the trucking industry. For more information, go to www.consumerfinance.gov/learnmore.

  • You may limit "prescreened" offers of credit and insurance you get based on information in your credit report. Unsolicited "prescreened" offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-567-8688.

  • You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.

  • Identity theft victims and active duty military personnel have additional rights. For more information, visit www.consumerfinance.gov/learnmore.

States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney General. For information about your federal rights, contact:
FOR QUESTIONS OR CONCERNS REGARDING: PLEASE CONTACT:
1.
a. Banks, savings associations, and credit unions with total assets of over $10 billion and their affiliates.

b. Such affiliates that are not banks, savings associations, or credit unions also should list, in addition to the Bureau:
a. Bureau of Consumer Financial Protection
1700 G Street NW
Washington, DC 20006

b. Federal Trade Commission: Consumer Response Center - FCRA
Washington, DC 20580
(877) 382-4357
2. To the extent not included in item 1 above:

    a. National banks, federal savings associations, and federal branches and federal agencies of foreign banks
    b. State member banks, branches and agencies of foreign banks (other than federal branches, federal agencies, and insured state branches of foreign banks), commercial lending companies owned or controlled by foreign banks, and organizations operating under section 25 or 25A of the Federal Reserve Act
    c. Nonmember Insured Banks, Insured State Branches of Foreign Banks, and insured state savings associations
    d. Federal Credit Unions
a. Office of the Comptroller of the Currency
Customer Assistance Group
1301 McKinney Street, Suite 3450
Houston, TX 77010-9050

b. Federal Reserve Consumer Help Center
P.O. Box 1200
Minneapolis, MN 55480

c. FDIC Consumer Response Center
1100 Walnut Street, Box #11
Kansas City, MO 64106

d. National Credit Union Administration
Office of Consumer Protection (OCP)
Division of Consumer Compliance and Outreach (DCCO)
1775 Duke Street
Alexandria, VA 22314
3. Air Carriers Asst. General Counsel for Aviation Enforcement & Proceedings
Department of Transportation
400 Seventh Street SW
Washington, DC 20590
4. Creditors Subject to Surface Transportation Board Office of Proceedings, Surface Transportation Board
Department of Transportation
1925 K Street NW
Washington, DC 20423
5. Creditors Subject to Packers and Stockyards Act Nearest Packers and Stockyards Administration area supervisor
6. Small Business Investment Companies Associate Deputy Administrator for Capital Access
United States Small Business Administration
406 Third Street, SW, 8th Floor
Washington, DC 20416
7. Brokers and Dealers Securities and Exchange Commission
100 F St NE
Washington, DC 20549
8. Federal Land Banks, Federal Land Bank Associations, Federal Intermediate Credit Banks, and Production Credit Associations Farm Credit Administration
1501 Farm Credit Drive
McLean, VA 22102-5090
9. Retailers, Finance Companies, and All Other Creditors Not Listed Above FTC Regional Office for region in which the creditor operates or Federal Trade Commission:
Consumer Response Center - FCRA
Washington, DC 20580
(877) 382-4357
Questions and/or consumer referrals may be made to:
Professional Screening & Information, Inc,
Post Office Box 644
Rome, Georgia 30162
Telephone (toll free): 706-235-7574 OR 1-877-235-7574
-- End of Report --
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