Date:
Secure Systems Group, Ltd.
958 Independence Drive
Dayton, OH 45429

Re: Request For Employment Background Investigation

       Name of Applicant/Employee:
       Social Security No.: DOB:

Dear Sir;

        Please initiate an Employment Background Investigation (EBI) for us on the above named employee/applicant.  The resulting report of investigation should be forwarded to at the above address.  The undersigned is authorized to bind the company with respect to this transaction, and certifies that:

  1. The purpose of this Employment Background Investigation is:   .

  2. We have completed the required Method of Payment Form, and attach same to this request. We have also attached your EBI Services Request Form to identify the specific inquiries we want you to perform as part of this EBI.

  3. We have attached a copy of your Employee/Applicant Information Form that was completed by the applicant/employee or, in lieu of that form, have attached a copy of our company's application form, annotated to identify specific fields we need to have verified as part of this EBI..

  4. In accordance with the requirements of the Fair Credit Reporting Act (FCRA), the undersigned hereby certifies on behalf of as follows:

  1. We would like to order an Employment Background Investigation Report (also known as a "Consumer Report") from you regarding the above-named applicant/employee. 

  2. The report is for employment purposes and will be used for no other purpose.  We will not use information in the report in a manner that violates federal or state equal employment opportunity laws or regulations.

  3. We have notified the applicant/employee that we might order such a report and we have obtained the applicant/employee's written consent to obtain said report.  The attached Applicant/Employee Authorization To Obtain Information Form  has been signed and dated by the applicant/employee, and a signed copy will be forwarded to you by mail or facsimile.

  4. If the report you provide to us pursuant to this request contains unfavorable or derogatory information about the applicant/employee, we will provide the applicant/employee with a copy of your report and a copy of the FCRA summary of his/her rights before taking adverse action, if any, against the applicant/employee.

         The above information is true and complete to the best of my knowledge.

          ______________________________    ___________________________   ________
                              Printed Name                                             Signature                                   Date
Encl: (4)


 

 

Form Instructions for Form Letter, Request for EBI

  1. Enter your company's name, address, city/state/zip, and telephone number in the header.

  2. Fill in all  informational blanks in the form.

  3. Print the form from your browser, and proof read.

  4. Sign the form letter you printed out and mail or fax it to us.  We need a signed letter and the four Attachments listed above before we can proceed.

  5. Enclose the following:
        EBI Service Request Form
         Method of Payment Form
         Employee/Applicant Identification Information Form or  Company Application Form
         Initial Notice and Consent To Obtain Background Investigation Reports signed  by Applicant/Employee