AP&J Corporate Screening Request Form
AP&J Fingerprinting & Identity Services provides identity verification, background screening coordination, and employment eligibility verification services for employers.
Company Information
Company Name
*
Company Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Business Type
*
Please Select
Construction Company
Staffing Agency
Healthcare Agency
Government Contractor
Security Firm
Other
Requested Service
Workforce Screening or Compliance Service Requested
*
Please Select
Mobile FD-258 Ink Fingerprinting (Licensing / Compliance)
Form I-9 Authorized Representative Verification
I-9 + Background Screening Package
Contractor Compliance Package
Corporate Workforce Compliance Package
Multiple Services Required
Please describe the services needed
Number of Applicants
Number of Applicants Requesting Service
*
Please Select
1
2–3
4–6
7–10
11–20
20+
Estimated time window needed
Please Select
1 hour
2 hours
Half day
Full day
Applicant Information
Applicant Information
Rows
Applicant Name
Phone Number
Email Address
Position / Role
Applicant 1
Applicant 2
Applicant 3
Applicant 4
Applicant 5
Applicant 6
Applicant 7
Applicant 8
Applicant 9
Applicant 10
Upload Applicant List
*
Browse Files
Drag and drop files here
Choose a file
If submitting more than 10 applicants, you may upload a spreadsheet instead of entering names individually.
Cancel
of
Applicant Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Position or Role
*
Mobile Appointment Location
Service Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Location Details
Provide building name, job site details, parking instructions, gate access, or security requirements.
Preferred Appointment Time
Preferred Date
*
-
Month
-
Day
Year
Date
Preferred Time Window
*
Please Select
Morning (8 AM – 11 AM)
Midday (11 AM – 2 PM)
Afternoon (2 PM – 5 PM)
Evening (5 PM – 7 PM)
On-Site Contact
On-Site Contact Name
*
First Name
Last Name
On-Site Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Additional information about your workforce request
Service Area Acknowledgement
*
I understand AP&J Fingerprinting & Identity Services provides mobile services within Stafford, Fredericksburg, and surrounding Northern Virginia areas and travel fees may apply depending on distance.
Submit
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