IQM: BUSINESS INVESTIGATIONS
PERSONAL SECURITY QUESTIONNAIRE
TO SCREEN AN APPLICANT OR VENDER

BASIC PERSONNEL SECURITY QUESTIONNAIRE (PSQ)

669 Airport Freeway
Hurst, Texas 76053
Phone: (817) 282-3377
Fax: (817) 282-8833
Email: iqm@crime-free.com

Instructions About The Use Of This Secure Electronic Personnel Screening Form

  1. Start by printing out this form and having the candidate read and sign the authorization and release.
  2. Next key in the candidate's personal data either on-line or off-line and SAFELY AND SECURELY send the Personnel Security Questionnaire (PSQ).
  3. To process Employment Verifications, Education, References, or Court Checks it is necessary to utilize Part B of the advanced PSQ; the Personnel Security Questionnaire.

CLIENT'S CASE REQUIREMENTS AND INSTRUCTIONS

CLIENT'S AUTHORIZATION

When submitting this form via the Internet, please use your PIN Number and date it. By doing this you are attesting that you have gathered and do possess the candidate's original signature on a copy of this authorization and release and that you have reviewed the candidate's supporting documents.  Should a former employer or agency of inquiry require a copy of the original, an investigating agent will request that you fax a copy of the original authorization and release.

Authorizer's Last Name First Name ;Title

Confidential PIN Number Enter the date of submission... : -- mm/dd/yyyy

CANDIDATE'S AUTHORIZATION AND RELEASE

I hereby authorize and request any person or other entity, including but not limited to present and former employers, schools, law enforcement agencies, insurance companies, financial institutes, government agencies, including all entities which have information relating to my employment history, special training, worker's compensation, education, and credit history, to furnish the representative of the business investigations agency with any and all information and copies of records in their possession regarding me in connection with my employment application. I further authorize the investigative agency to release the results of the background check to my prospective employer. By signing below, I hereby release and hold harmless the owners of the business investigations agency, and their client, and their directors, officers, employees, and agents from claims arising out of or in any connection with their legitimate gathering or disclosures of information as authorized by this release. I am willing that a copy of this Authorization and Release be accepted with the same authority as original. Supporting documents are reviewed by the witness.

Applicant's Signature___________________________________________________

Social Security Number ________/________/__________ Date ______ /_____ /_____

CANDIDATE'S BASIC HISTORICAL DATA

Last Name First Name Middle Name

Alias (e.g. Maiden Name, Frequently Used Nick Name)

Provide A Physical Description For True Identity Verification Purposes Only

I Decline To Provide A Physical Description

Physical Description

Height in inches Weight in pounds

Color of Eyes Color of Hair

Date And Place Of Birth

Date of birth -- mm/dd/yy   Social Security Number

Non-U.S.A. Identification Number Issuing Nation

Birth City County State/Providence Nation

Current Data

Present Street Address Apt. Number

City County State Zip

Nation; Home Phone-AC Number

Explanatory Note

Driver License Number State Enter the date of expiration : -- mm/dd/yyyy

Support Documentation (e.g.: INS Permit or a birth certificate):

Document Type Number

CANDIDATE'S CRIMINAL CONVICTION AND DRIVING VIOLATIONS HISTORY

  1. Have you ever been convicted, or found guilty, of violating any law? Yes No

  2. If you have answered yes,
    please provide detailed information on the next advanced Questionnaire, entitled Criminal History Research, for each offense.

  3. If you answered no, to the criminal history question, and we are not making further inquiry into your Employment Verifications, Education or References, you are finished and may submit the form now.

ADVANCED PERSONNEL SECURITY QUESTIONNAIRE(S)

  1. To process Employment Verifications, Education, References, or Court Checks it is necessary to utilize an advanced PSQ; the Personnel Security Questionnaire.
  2. If your entries are complete, you may submit the data by clicking on the Submit Button above.
  3. Select which advanced PSQ that you require from the buttons below.

Additional Advanced Forms

  1. Authorization and Release Statement
  2. Criminal and Driving History
  3. Educational, Training and Military Attainment
  4. Employment Activity Detailed
  5. Basic Personnel Security Questionnaire
  6. Character References