Phoenix Teknologies Background Check Consent Form
PLEASE FILL OUT APPLICATION IN ITS ENTIRETY AS TO AVOID ANY HIRING DELAYS. GOT QUESTIONS? SEND US AN EMAIL: SUPPORT@PHOENIX-TEKNOLOGIES.COM
I. Personal Information
Full Name
First Name
Last Name
Alias (If any)
Previous name (If any)
First Name
Last Name
Present Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Previous Address (If any)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Do you have an Android or Iphone
Android
Iphone
Are you at least 25 years or older? In Florida and Indiana you must be 25 years old.
YES
NO
Do you have a valid Driver License
YES
NO
Do you have all of the following:
2011 or newer (Florida)
Indiana 2009 newer (Gary, Terre Haute, Muncie) 2007 or newer (all other cities)
5-8 seater vehicle
Not titled as salvaged, non-repairable or rebuilt vehicle
4 door
YES
NO
II. Criminal History Background Check Consent Form
1. Have you been apprehended, charged or convicted for a crime of violation of law?
Yes
No
2. Are you on probation or parole?
Yes
No
If the answer is Yes to any of the questions above, please provide place, date and violation details on the box:
Birthdate
-
Month
-
Day
Year
Date
Place of birth
Social Security Number (Used for Identity Verification and 1099 Tax Form)
Citizenship
I hereby declare that the information submitted in this application is true and correct to the best of my knowledge. I understand that any false information will result to disqualifying this application. I hereby authorize Phoenix Teknologies and its representatives to perform an extensive review of my background which includes Motor Vehicle Records (Drivers License check), County, State, and Federal Background Check and Sex Offender Registry Check, based on private and public information I have provided for employment purposes. I also authorized any agencies or background check companies to perform a background check investigation as part of my application.I fully understand that this investigation will generate a report that may include personal information, education background, employment history, character references, birth records and any other records. I, therefore release and hold no harm to any representatives or Phoenix Teknologies who provides this information from any liability.
Please upload your driver license here (PLEASE MAKE SURE PICTURE IS CLEAR)
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Please upload your insurance here (PLEASE MAKE SURE PICTURE IS CLEAR)
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Upload your W9 here. If you do not have one, you can obtain it here: https://www.irs.gov/pub/irs-pdf/fw9.pdf
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