Employment Background Investigation
Service Request




Please Follow The Numbered Instructions Below:

  

  

    1.    Enter the Name, Date of Birth,  and Social Security No. of the subject of this EBI.
                   
            Name (Last, First, MI.)                                            Date of Birth     Social Security No.

    2.    Check the "Order" block in the following table for each inquiry you want us to accomplish
            and include in our report to you. 

Order Type Inquiry

Services Included

 Unit Cost
Basic Information Report The BIR verifies addresses, date of birth, social security number, and other identification data. The BIR normally develops additional information regarding subject's prior addresses, registered vehicles, current/former spouses, and identities of other adults living at the same address. The BIR is a required element of all Background Investigations because it helps us ensure that the subject is not using a fictitious identity.

$25.00
Criminal History Check Query of reporting service to obtain records of felony convictions reported by local, state, and federal agencies. The CHC will not provide arrest records, records of misdemeanor offenses, records that have been administratively expunged, or criminal histories that predate automated reporting systems (usually prior to 1990).  This records check may miss recent criminal charges because this database is only updated on a quarterly basis, but it is a relatively inexpensive inquiry that covers all states. 

$25.00
Ohio Attorney General Webcheck Submission of fingerprint card and identification data from individual's drivers license to Ohio BCII for record of any criminal conviction in the State of Ohio.

$35.00
FBI Fingerprint Card Submission of fingerprint card and identification data from individual's drivers license to Federal Bureau of Investigation for records of criminal convictions. The turn around time on this request may be up to 90 days.

$35.00
State Criminal History Check Search of reporting service data base of state records by subject name to disclose records of felony and state-level misdemeanor convictions. For Ohio this inquiry searches Ohio Bureau of Prisons records on persons convicted and sentenced to serve time in a state correctional institution since 1988.  Records are on file for approximately 255,000 people. The results show defendant's name, month and year of birth, race, sex, offense description, sentence, date of sentence, and county of disposition. The information base is updated monthly.  This check can be run for the same person in other states, but the databases for each state are slightly different. Our reports provide the user with an explanation, similar to the above, on what the State database contains. The CHC may be requested for multiple states of residence. Use remarks section below to add other States. The CHC may not include records of offenses where subject received probation or jail time in a local County Jail.

 $15.00
Per State
County Filings We search Municipal Court records for criminal and misdemeanor offenses and civil filings using the subjects name and date of birth in each county of residence reflected on the application, and in other counties of residence we identify as a result of our inquiries. Use the Client Remarks section below to identify the specific Counties in which you want these records checks to be performed.  Our search is generally limited to counties with automated reporting systems, and generally does not go back more than ten years.  If your request is for an Employment Background Investigation, the Fair Credit Reporting Act limits our report to Civil Lawsuits or Judgments less than seven years old. If your request is for a General Background Investigation (not for employment purposes) we can do an extended manual check of civil filings that will research all historical records for the past twenty years for $75.00.

$25.00
Per County
Bankruptcy History  Records check in Federal District Bankruptcy Court in jurisdiction where subject resides, or where business is located to identify prior Bankruptcy filings.  Also includes an online search of a proprietary data service for Bankruptcy filings in other jurisdictions. If request is for an Employment Background Investigation, the Fair Credit Reporting Act limits our report to filings within the past ten years.

$25.00
Secretary of State Inquiries Search of State records by subject and/or business name to identify all business organization and UCC filings in the state of residence. Use remarks section below to add other States.

$25.00
Licensing/Credential Check Verify the status of any license or credential reported by subject through inquiries to appropriate State Medical Boards or Licensing Activities in state where subject resides. Includes search for records of complaints/investigations involving subject. Use remarks section to add other States.     $100.00
 

 

Educational Background Check (EBC)

  

Written requests to educational institutions listed by subject to verify attendance and degrees or certifications earned by subject.  Use remarks section below to specify Educational Institutions from which you would like such verification.

  

  $75.00
Personal Credit History A comprehensive report that reflects the credit history and credit rating of the subject.

$50.00
Business Credit History A report that reflects the business credit history and rating of subject company.

$50.00
Asset Screening Search using several nationwide data bases to locate residential properties, vacation properties, vehicles, aircraft, boats and other personal property titled to subject or subject's spouse.

$20.00
Workman's Comp Claims We can research statewide histories for any past filings by your claimant. The following states require NO signed release: AK, AZ, AR, CA, DE, FL, IL, IA, KY, LA, MY, MI, MS, NE, NM, OH, OK, TN, and TX. All other states require a signed release from the claimant.

$30.00
State Driving Record  Check the subject's driving history for possible accidents or citations. This search is NOT available in AR, GA, HI, or KY. 

$25.00
References and Prior Employers List all references or prior employers you want to have contacted in the Client Remarks box below. We will interview them regarding the applicant's reliability, trustworthiness, suitability for the position they are seeking, their ability to work with others, their job skills, their emotional stability, and the circumstances surrounding their discharge/resignation. We will provide a written report on the results of these interviews and identify any additional references that these interviews develop.

$25.00
Neighborhood Check Our agents will personally contact up to five of the subject's neighbors to develop information regarding their lifestyle, habits, and relationships, and any knowledge neighbor's may have regarding the subject's background or suitability for employment. We recommend that applicants for employment be advised that such checks are being included in their EBI.

$190.00
  Pre Sales Tax Subtotal

  Ohio Sales Tax (6%, 7%, or 7.5% depending on your County)  Tax Help

  Total Cost (Add Pre-Tax Subtotal and Sales Tax)

Unit costs described above are based on the rates of this company.  If a subcontractor is required to properly complete a requested element of this investigation, and the costs for such services will exceed our standard prices, you will be advised prior to initiation.

    3.      Enter any special instructions you have for us, below, or attach a separate sheet:

    4.    Print this form to Fax/Mail with your Request to:
                     Secure Systems Group, Ltd.
                     958 Independence Drive
                     Dayton, OH 45429
                     Phone: (937) 673-4546 Fax: (937) 434-6060
    5.    Use Reset to Enter New Data.               


Secure Systems Group, Ltd.
Copyright © 2003 Secure Systems Group, Ltd. All rights reserved.
Revised: April 06, 2006