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

Candidate's Employment Activity Detailed

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

CLIENT'S AUTHORIZATION

Reminder: This is an advanced form.  Work Order and Candidate Authorizarion must be completed first.

Candidate's Last Name Social Security Number

Client's PIN Client's Code Enter the date of submission : -- mm/dd/yyyy

CLIENT'S CASE REQUIREMENTS AND INSTRUCTIONS

Instructions About Reporting Candidate's Employment Activity

The investigators may verify your claimed periods of: Employment, Self-Employment, Unemployment, Educations, Training and Military Services. In addition to checking dates of the activity, questions will be asked concerning your performance and behavior.

Begin with your last period of activity: employment, self-employment, unemployment, education, training, institutional or military service. You may still be employed on another job. If so, that is where you start.

You must CAREFULLY, CONSISTENTLY and CHRONOLOGICALLY account for MAJOR periods of time (usually 30 days or more) during the scope of this investigation. The period of time to be covered will be defined by your proctor. In some cases, the activity periods may overlap, for example school attendance and work or a job and the National Guard. That is OK.

Only three activity blocks are provided. You may need more. When you have additional activity blocks to report, SUBMIT the three blocks that are completed, RESET the form. Go back to the top and add your personal identification data and enter the next three activity blocks.

ACTIVITY A.

Describe Your Most Recent Major Activity Period:

Dates of Activity:

Enter the Start date : -- mm/dd/yyyy

Enter the Stop date : -- mm/dd/yyyy
  • If you were UNEMPLOYED during this period, leave the organizational questions blank. Instead go on to the block on about the Alternate Verification".

Organization Or Employer Name

Organization Name Division/Unit

Organization  A. Phone-AC Number Ext Fax-AC Number

Activity Location

Address/Street Name

City County State Zip

Your Position/Title While On This Job

Why Did You Leave This Activity?:

Activity Supervisor And Employment Conditions

First Name Last Title

Did this employer screen for drugs? Do pre-employment check?

Address/Street of your residence during this activity

City County State Zip

Alternate Verifier

Provide details about an alternate person, a non-relative, who can verify this reported activity.

First Initial Last

Relationship

Verifier A: Phone-AC Number Ext Fax-AC Number

Additional comments about this activity?

ACTIVITY B.

Describe Your Most Recent Major Activity Period:

Dates of Activity:

Enter the Start date : -- mm/dd/yyyy

Enter the Stop date : -- mm/dd/yyyy
  • If you were UNEMPLOYED during this period, leave the organizational questions blank. Instead go on to the block on about the Alternate Verification".

Organization Or Employer Name

Organization Name Division/Unit

Organization  B. Phone-AC Number Ext Fax-AC Number

Activity Location

Address/Street Name

City County State Zip

Your Position/Title While On This Job

Why Did You Leave This Activity?:

Activity Supervisor And Employment Conditions

First Name Last Title

Did this employer screen for drugs? Do pre-employment check?

Address/Street of your residence during this activity

City County State Zip

Alternate Verifier

Provide details about an alternate person, a non-relative, who can verify this reported activity.

First Initial Last

Relationship

Verifier B: Phone-AC Number Ext Fax-AC Number

Additional comments about this activity?

ACTIVITY C.

Describe Your Most Recent Major Activity Period:

Dates of Activity:

Enter the Start date : -- mm/dd/yyyy

Enter the Stop date : -- mm/dd/yyyy
  • If you were UNEMPLOYED during this period, leave the organizational questions blank. Instead go on to the block on about the Alternate Verification".

Organization Or Employer Name

Organization Name Division/Unit

Organization  C. Phone-AC Number Ext Fax-AC Number

Activity Location

Address/Street Name

City County State Zip

Your Position/Title While On This Job

Why Did You Leave This Activity?:

Activity Supervisor And Employment Conditions

First Name Last Title

Did this employer screen for drugs? Do pre-employment check?

Address/Street of your residence during this activity

City County State Zip

Alternate Verifier

Provide details about an alternate person, a non-relative, who can verify this reported activity.

First Initial Last

Relationship

Verifier A: Phone-AC Number Ext Fax-AC Number

Additional comments about this activity?

ACTIVITY D.

Describe Your Most Recent Major Activity Period:

Dates of Activity:

Enter the Start date : -- mm/dd/yyyy

Enter the Stop date : -- mm/dd/yyyy
  • If you were UNEMPLOYED during this period, leave the organizational questions blank. Instead go on to the block on about the Alternate Verification".

Organization Or Employer Name

Organization Name Division/Unit

Organization  D. Phone-AC Number Ext Fax-AC Number

Activity Location

Address/Street Name

City County State Zip

Your Position/Title While On This Job

Why Did You Leave This Activity?:

Activity Supervisor And Employment Conditions

First Name Last Title

Did this employer screen for drugs? Do pre-employment check?

Address/Street of your residence during this activity

City County State Zip

Alternate Verifier

Provide details about an alternate person, a non-relative, who can verify this reported activity.

First Initial Last

Relationship

Verifier D: Phone-AC Number Ext Fax-AC Number

Additional comments about this activity?

 

ADVANCED PERSONNEL SECURITY QUESTIONNAIRE(s)

  1. To process Employment Verifications, Military Service, Education, or Special References,  it is necessary to utilize additional advanced PSQ (s); ( Personnel Security Questionnaire ).
  2. If your entries are complete, you may submit the data by clicking on the Submit Button above.
  3. Select  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