• USA INVESTIGATIONS, LLC

    2101 VISTA PARKWAY, SUITE 310

    WEST PALM BEACH, FL 33411

  • This is USA Investigations’ client questionnaire for individuals who are seeking background check only. You will need to complete two forms. Please note that some of the questions are repetitive. Please answer all questions. If any of the questions do not pertain to you, enter N/A in that section. Once you complete the form you will receive a copy of your answers for your review. You will also have an opportunity to preview your responses before submitting your form. To preview the form, click on the preview tab at the end of the form. To return to the form, click on the “Return to Form tab at the top of the first page.

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  • PLEASE CIRCLE ONE OF EACH:

  • For Criminal History Record Checks

    This form shall be completed and signed by every current or prospective employee and/or volunteer.

  • I hear by authorized (Enter Name of Qualified Entity)        to submit a set of my fingerprints and this form to the Florida Department of Law Enforcement (FDLE) for the purpose of accessing and reviewing Florida and National criminal history records that may pertain to me. I understand that I would be able to receive any national criminal history record that may pertain to me directly from the Federal Bureau of Investigation (FBI). Pursuant to Title 28 Code of Federal Regulation (CFR) section 16.30.-16.34 I could then freely disclose any such information to whom I choose.

  • By signing this Walver Agreement, It is my intent to authorize the dissemination of any national criminal history record that may pertain to me to the Qualified Entity with which I am or am seeking to be employed or to serve as a volunteer. I understand that, upon request you may provide me a copy of the criminal history record report, and thatI am entitled to challenge the accuracy and completeness of any information contained in any such report. I am aware that procedures for obtaining a change, correction, or updating of the FDLE or FBI criminal history are set forth in F.S. 943.056 and Title 28, CFR, Section 16.34. I may obtain a prompt determination as to the validity of my challenge before you make a final decision about my status as an employee and/or volunteer.

    A national criminal history record check has previously been requested by:

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